Ultrasound- and CT-Guided Medial-to-Lateral Radiofrequency Ablation of the Infraorbital Nerve for Persistent Idiopathic Dentoalveolar Pain: A Trajectory-Based Approach

TL;DR

A new ultrasound- and CT-guided approach for targeting the infraorbital nerve is described to treat persistent tooth pain that does not respond to other treatments.

Contribution

A novel medial-to-lateral trajectory-based RFA technique is introduced to improve infraorbital nerve targeting for PIDAP.

Findings

Ultrasound and CT guidance enabled accurate identification of the infraorbital foramen and canal orientation.

The patient experienced immediate and sustained pain relief with no complications.

A mild symptom rebound was observed at two months, but the technique remains promising for refractory PIDAP.

Abstract

Persistent Idiopathic Dentoalveolar Pain (PIDAP) is a persistent idiopathic toothache that frequently remains unresponsive to medical therapy. Precise targeting of the infraorbital nerve is essential for successful intervention, yet anatomical variability often limits the consistency of conventional radiofrequency ablation (RFA). This report describes a medial-to-lateral ultrasound- and computed tomography-guided approach, intended to align with the natural orientation of the infraorbital canal and potentially enhance electrode–nerve contact. A 48-year-old woman with refractory maxillary incisor pain underwent RFA after only transient benefit from a diagnostic nerve block. Ultrasound enabled accurate identification of the infraorbital foramen and confirmed the canal’s medial-to-lateral course, which then guided CT-assisted needle advancement into the orbitomaxillary segment. The patient experienced immediate analgesia. Pain reduction was maintained at the one-month follow-up. At the two-month assessment, although a mild symptom rebound was observed, no procedure-related complications were noted. This trajectory-based medial-to-lateral technique offers an anatomically grounded alternative for infraorbital nerve RFA and may represent a valuable option for refractory PIDAP.

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