This article reports the relief of severe causalgia of the right infra-orbital nerve by nerve section and re-location in a 14-year-old boy who had worsening neuropathic pain (NP) and was housebound and refractory to all analgesics for 14 months. His infra-orbital nerve was sectioned and re-located into his buccal fat pad. Severe steady burning, electric shock-like pain and allodynia disappeared and he was able to return to school and an increasingly normal life at one year post-operatively and is pain-free at 3 years and 6 months of follow-up. With NP further deafferentation can cause a worsening of the pain or anaesthesia dolorosa. In this instance there was dramatic and then sequential, gradual and complete resolution of all components of this particular form of NP. Therefore, in selected patients with causalgia this nerve re-location technique may help in symptom resolution and improve quality of life.
aDepartment of Medicine, University of Toronto, Canada
bHospital for Sick Children and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
cDepartment of Physiology, University of Toronto, Canada
dDepartment of Pathology, University of Toronto, Canada
eDepartment of Surgery, University of Toronto, Canada
*Corresponding author. 1 Sir Williams Lane, Etobicoke, Ontario, Canada M9A 1T8. Tel.: +1 416 239 3494; fax: +1 416 239 6365.
Submitted February 10, 2007; received in revised form June 29, 2007; accepted July 25, 2007.