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Title: Skullbase Osteomyelitis (SBO) Pain Management With Low Dose Neuromodulators And Newer Approach Of Muscular Interventions By USGDN (Ultrasonography Guided Dry Needling) With Additional Benefit Of Improvement In Facial Palsy. A Case Report.
e-poster Number: INSIM88
Category: Pain
Author Name: Dr Amit Anil Bhalerao
Institute: TNMC & BYL Nair Hospital
Co-Author Name: Dr Varsha S Suryavanshi, Dr. Manish Patil
Abstract :
Aim
To explore a novel perspective of myofascial pathology as a cause of pain in SBO
To describe management of pain and disability with USGDN and neuromodulation.
Introduction: SBO is a life threatening condition common in diabetes mellitus (DM) and otitis externa.
57 yrs male, SBO with DM, pain VAS 10/10, facial palsy, dribbling of saliva and fall of food from mouth.
Pain over scalp, neck, face. received Inj Paracetamol and tramadol in ward. We added tab Pregabalin 75 mg od.
Results: After 7days of treatment, VAS was 6/10 and there was no change in palsy. Started USGDN with 32G solid needles addressed facial, scalp, neck muscles. After 2 sessions VAS 2/10 with relief from facial palsy symptoms suggesting that there was entrapment of facial nerve. Total 4 sessions done.
Discussion: Active infection causes inflammation of skull base. Muscles arising from skull base go into severe spasm causing pain led to generation of myofascial trigger points (MTrPs). Further entrapment of cranial nerves as they pass through their foramina guarded by these muscles probably led to the cranial nerve palsy (CNP). Earache is often attributed to 9th nerve however from myofascial perspective it can also be attributed to MTrPs in sternocleidomastoid, masseter and pterygoid muscles. Insertion of needle produces a local twitch reflex (LTR) followed by muscle relaxation leading to uniform lasting pain relief and improvement in facial palsy.
Conclusion: USGDN proved to be very effective in addressing the intense suffering of SBO as well as severe morbidity secondary to CNP.
