To Report the effect of Subdermal BOTOX injection on Neuropathic pain

Ramsay Hunt Syndrome (RHS) which is caused by the spread of the varicella-zoster virus to facial nerves, is characterized by intense ear pain, a rash around the ear, face, neck, and scalp, and paralysis of facial nerves

We present a case of 51-year-old female suffering from RHS with severe ear lobe Neuropathic pain  treated effectively with subdermal BOTOX injection. 

She developed severe neuropathic pain in the left ear and Left scalp areas. . The scalp Neuropathic pain responded to Pharmacologic treatments and nerve block.

However, Left ear lobe and external canal Neuropathic pain as hyperesthesia and allodynia became status and intractable. She reported inability to touch her ear, comb her hair or sleep on her left side.

The skin of the external auditory meatus  is innervated by the sensory component of the intermediate nerve branch of facial Nerve. The Ear lobe has a more complicated sensory nerves innervation by C2, C3, V3, and CN X.

Recent studies have suggested that BoNT injection is an effective treatment for postherpetic neuralgia and is likely efficient for Trigeminal neuralgia and Post-Traumatic Neuralgia. 

We used Botulinum TOX A. /BOTOX 60 units subdermal administration to Left ear lobe and external canal with moderate decreased in Neuropathic pain with duration of pain relief up to 3 months. There was no associated side effect.

Patient was able to touch her ear, sleep on that side and even use her ear rings again.

The mechanism behind the antinociceptive effects of BOTOX suggest that it inhibits the release of peripheral neurotransmitters and inflammatory mediators from sensory nerves. There is some evidence showing the retrograde axonal transport of BoNT.