Managing refractory trigeminal neuralgia (TN) remains a significant challenge for pain specialists and neurologists. A recent retrospective study has shed light on the efficacy of mandibular nerve pulsed radiofrequency (PRF) when combined with low-dose perineural dexamethasone. This ultrasound-guided approach offers a minimally invasive alternative for patients who suffer from debilitating V3-distributed facial pain. Specifically, the integration of real-time imaging enhances precision while minimizing the risks associated with traditional fluoroscopic techniques.

Researchers analyzed 73 consecutive patients treated over a three-year period. Consequently, they observed a dramatic reduction in pain intensity. The mean Numeric Rating Scale (NRS) score dropped from nearly 7.0 at baseline to 2.22 at one month post-procedure. Although some pain intensity returned slightly by the six-month mark, the scores remained significantly lower than pre-treatment levels. Furthermore, the adjunct use of dexamethasone appeared to mitigate post-procedure inflammation, leading to high patient satisfaction and improved functional status.

Benefits of Mandibular Nerve Pulsed Radiofrequency

The safety profile of this neuromodulatory technique is particularly noteworthy. Unlike thermal radiofrequency ablation, PRF does not rely on high temperatures to destroy nerve tissue. Instead, it uses electromagnetic fields to modulate pain signals at temperatures below 42°C. This distinction is vital because it reduces the incidence of sensory loss and anesthesia dolorosa. Moreover, the study reported no major complications, such as motor weakness or permanent numbness. Similarly, the reintervention rate remained low, suggesting that this protocol provides durable relief for many patients.

Clinicians should consider this ultrasound-guided method when medical management fails. Additionally, the transition to ultrasound allows for point-of-care delivery without exposing patients to radiation. In conclusion, the combination of V3 PRF and dexamethasone represents a promising, safe, and effective strategy for chronic facial pain management.

Frequently Asked Questions

How does pulsed radiofrequency differ from traditional thermal ablation?

Pulsed radiofrequency is a non-destructive technique that uses electrical pulses to modulate nerve function without exceeding 42°C. In contrast, thermal ablation uses high heat to create a lesion, which carries a higher risk of permanent sensory deficits.

Why is dexamethasone added to the procedure?

Dexamethasone serves as an anti-inflammatory adjunct. It helps reduce perineural edema and potential neuritis caused by needle placement or the electromagnetic field, thereby improving short-term recovery and comfort.

Is ultrasound guidance better than fluoroscopy for V3 PRF?

Ultrasound provides real-time visualization of soft tissues and vascular structures. This helps the clinician avoid blood vessels and ensures more accurate needle placement at the mandibular nerve without radiation exposure.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Küçükbingöz Ç et al. Ultrasound-Guided Mandibular Nerve Pulsed Radiofrequency With Adjunct Dexamethasone in Trigeminal Neuralgia: A Retrospective Cohort Study. J Craniofac Surg. 2026 Jun 01. doi: 10.1097/SCS.0000000000012964. PMID: 42224005.

Zhao C, Ren H, Shrestha N, et al. The efficacy of combining pulsed radiofrequency with low-temperature continuous radiofrequency for the treatment of primary trigeminal neuralgia: a randomized controlled trial. J Neurosurg. 2025;143(1):100-110. doi: 10.3171/2024.10.JNS241274.

Can E, Genç Perdecioğlu GR, Yıldız G, et al. Evaluation of the efficacy of ultrasound-guided maxillary and mandibular nerve pulsed radiofrequency treatment for trigeminal neuralgia and factors associated with successful response: a retrospective study. Acta Neurol Belg. 2025 Feb;125(1):109-117. doi: 10.1007/s13760-024-02638-2.