Trigeminal neuralgia is a chronic pain condition associated with sharp, shock-like pain in one or more divisions of the trigeminal nerve. For patients who do not respond well to pharmacotherapy, there is growing evidence that Botulinum toxin type A injections into the trigeminal ganglion provide pain relief for several weeks up to several months at a time. One option is to administer injections into the trigeminal ganglion in Meckel’s cave by inserting a needle through the Pterygopalatine Fossa using fluoroscopy to guide and confirm the proper needle placement. However, there is evidence that Botulinum toxin travels across nerve synapses; thus, injecting directly into the trigeminal ganglion may not be necessary. We present two patients with a confirmed diagnosis of trigeminal neuralgia who were treated by injecting Botulinum toxin type A intraorally into the mental foramen which resulted in 6 months or longer of pain relief. Injections into the mental foramen are much easier to administer than those administered directly into the trigeminal ganglion, and both patients treated with this technique experienced comparable results to what can be expected from traditional fluoroscopy-guided botulinum toxin injections. Though more research is needed, these cases potentially imply that a less-invasive injection may be sufficient in managing trigeminal neuralgia-related pain.

When patients present with deep space neck infections, typically the treatment involves Incision and Drainage (I&D) with an extraoral incision that could measure several centimeters in length, as well as antibiotic administration. While this approach is effective in managing these types of infections, it is not without limitations. Most notably, patients treated with I&Ds often are subject to prolonged hospitalization due to sepsis and they complain of a permanent, unsightly scar in the facial or cervical region once healed. In this case report, a 28-year-old male patient presenting to the emergency room with a right mandibular space collection of suppuration is treated with a modified version of the Seldinger technique which provided adequate abscess drainage and a more cosmetically-pleasing outcome once healed. Furthermore, this patient was treated bedside under local anesthesia as opposed to in an operating room under general anesthesia. While this technique may not be indicated for every patient presenting with deep space neck infections, it is a less-invasive approach that was effective for this patient.

For patients suffering from myofascial pain syndrome (MPS) affecting muscles of mastication, traditional trigger point therapy treatment regimens can prove inconvenient, due to the short duration of pain relief after each injection and expense of repeated visits which are often not covered by insurance. We present a case of a patient treated using an alternative technique that could develop into an additional modality for treating MPS patients who are refractory to conservative treatment. This technique involves identifying and marking the patient’s trigger points and surgically cauterizing each location using a Bovie electrosurgical unit. While traditional trigger point injection therapy for myofascial pain syndrome is a well-described technique with acceptable pain relief expected for a period of 8–12 weeks, this technique provided up to 24 months of adequate pain relief in a patient. While further studies are indicated before widespread adoption can be recommended, this patient’s response suggests that this technique may be useful in offering longer-term pain relief compared with trigger point injection therapy.