{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:55:25Z","timestamp":1790729725622,"version":"4.1.0"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,9,28]]},"abstract":"\n BACKGROUND<\/jats:title>\n Trigeminal neuralgia (TN) classically presents with paroxysmal facial pain in the V2 or V3 distributions. Rarely, symptoms localize to the anterior tongue, mimicking peripheral lingual nerve pathology or glossopharyngeal neuralgia.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n Two older women presented with refractory right-sided tongue pain. Case 1 was an 80-year-old woman with sublingual pain evolving from shock-like paroxysms to continuous burning, with no neurovascular compression (NVC) demonstrated on preoperative MRI. Case 2 was a 71-year-old woman who underwent Gamma Knife radiosurgery and lingual nerve exploration for presumed peripheral pathology without relief, despite MRI showing venous loops at the root entry zone. Both had NVC at the trigeminal root confirmed intraoperatively and achieved complete pain resolution after microvascular decompression.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n TN can present as isolated tongue pain due to proximal pathology at the trigeminal root. Misattribution to peripheral lingual nerve disease can lead to unnecessary interventions. Negative MRI findings do not exclude the diagnosis when clinical features are compelling.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE26480<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case26480","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:04:20Z","timestamp":1790121860000},"source":"Crossref","is-referenced-by-count":0,"title":["When tongue pain is trigeminal neuralgia: illustrative cases"],"prefix":"10.3171","volume":"12","author":[{"given":"Zahraa F.","family":"Al-Sharshahi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Kentucky, Lexington, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Pittman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Kentucky, Lexington, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8","key":"bib1","series-title":"N Engl J Med","first-page":"754","article-title":"Trigeminal neuralgia","volume":"383","author":"Cruccu","year":"2020","unstructured":"Cruccu GDi Stefano GTruini A.Trigeminal neuralgia. N Engl J Med. 2020;383(8):754-762. doi:10.1056\/NEJMra1914484"},{"issue":"9","key":"bib2","series-title":"Lancet Neurol","first-page":"784","article-title":"Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia","volume":"19","author":"Bendtsen","year":"2020","unstructured":"Bendtsen LZakrzewska JMHeinskou TBAdvances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol. 2020;19(9):784-796. doi:10.1016\/S1474-4422(20)30233-7"},{"issue":"12","key":"bib3","series-title":"Brain","first-page":"2347","article-title":"Trigeminal neuralgia: pathology and pathogenesis","volume":"124","author":"Love","year":"2001","unstructured":"Love SCoakham HB.Trigeminal neuralgia: pathology and pathogenesis. Brain. 2001;124(12):2347-2360. doi:10.1093\/brain\/124.12.2347"},{"issue":"5","key":"bib4","series-title":"J Oral Maxillofac Surg","first-page":"926.e1","article-title":"Clinical anatomy of the lingual nerve: a review","volume":"75","author":"Sittitavornwong","year":"2017","unstructured":"Sittitavornwong SBabston MDenson DZehren SFriend J.Clinical anatomy of the lingual nerve: a review. J Oral Maxillofac Surg. 2017;75(5):926.e1-926.e9. doi:10.1016\/j.joms.2017.01.009"},{"issue":"7","key":"bib5","series-title":"Clin Anat","first-page":"756","article-title":"Lingual nerve revisited\u2014a comprehensive review part II: surgery and radiology","volume":"38","author":"Ono","year":"2025","unstructured":"Ono KNishioka TObata KLingual nerve revisited\u2014a comprehensive review part II: surgery and radiology. Clin Anat. 2025;38(7):756-769. doi:10.1002\/ca.24211"},{"issue":"6","key":"bib6","series-title":"J Am Dent Assoc","first-page":"497","article-title":"Trigeminal neuralgia originating in the tongue: from misdiagnosis to clarity","volume":"156","author":"Daryani","year":"2025","unstructured":"Daryani DUnni JV.Trigeminal neuralgia originating in the tongue: from misdiagnosis to clarity. J Am Dent Assoc. 2025;156(6):497-503. doi:10.1016\/j.adaj.2025.03.010"},{"issue":"3","key":"bib7","series-title":"Lancet Neurol","first-page":"257","article-title":"Facial pain: clinical differential diagnosis","volume":"5","author":"Siccoli","year":"2006","unstructured":"Siccoli MMBassetti CLS\u00e1ndor PS.Facial pain: clinical differential diagnosis. Lancet Neurol. 2006;5(3):257-267. doi:10.1016\/S1474-4422(06)70375-1"},{"issue":"1","key":"bib8","series-title":"Pain Physician","first-page":"39","article-title":"Retrospective analysis of clinical feature in trigeminal neuralgia","volume":"26","author":"Hong","year":"2023","unstructured":"Hong JHLee JYKim SJSeo KH.Retrospective analysis of clinical feature in trigeminal neuralgia. Pain Physician. 2023;26(1):39-44. doi:10.36076\/ppj.2023.26.39"},{"issue":"2","key":"bib9","series-title":"Brain","first-page":"531","article-title":"Topography of the pain in classical trigeminal neuralgia: insights into somatotopic organization","volume":"143","author":"Sindou","year":"2020","unstructured":"Sindou MBrinzeu A.Topography of the pain in classical trigeminal neuralgia: insights into somatotopic organization. Brain. 2020;143(2):531-540. doi:10.1093\/brain\/awz407"},{"issue":"14","key":"bib10","series-title":"Cephalalgia","first-page":"1645","article-title":"Mapping the trigeminal root entry zone and its pontine fibre distribution patterns","volume":"40","author":"Guberinic","year":"2020","unstructured":"Guberinic ASouverein VVolkers RMapping the trigeminal root entry zone and its pontine fibre distribution patterns. Cephalalgia. 2020;40(14):1645-1656. doi:10.1177\/0333102420959796"},{"key":"bib11","series-title":"World Neurosurg","first-page":"e216","article-title":"The role of preoperative magnetic resonance imaging in assessing neurovascular compression before microvascular decompression in trigeminal neuralgia","volume":"168","author":"Xu","year":"2022","unstructured":"Xu RNair SKRaj DThe role of preoperative magnetic resonance imaging in assessing neurovascular compression before microvascular decompression in trigeminal neuralgia. World Neurosurg. 2022;168:e216-e222. doi:10.1016\/j.wneu.2022.09.092"},{"issue":"12","key":"bib12","series-title":"Acta Neurochir (Wien)","first-page":"3321","article-title":"Microvascular decompression in trigeminal neuralgia: predictors of pain relief, complication avoidance, and lessons learned","volume":"163","author":"Herta","year":"2021","unstructured":"Herta JSchmied TLoidl TBMicrovascular decompression in trigeminal neuralgia: predictors of pain relief, complication avoidance, and lessons learned. Acta Neurochir (Wien). 2021;163(12):3321-3336. doi:10.1007\/s00701-021-05028-2"},{"issue":"17","key":"bib13","series-title":"N Engl J Med","first-page":"1077","article-title":"The long-term outcome of microvascular decompression for trigeminal neuralgia","volume":"334","author":"Barker","year":"1996","unstructured":"Barker FGJannetta PJBissonette DJLarkins MVJho HD.The long-term outcome of microvascular decompression for trigeminal neuralgia. 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