Case Report: Ultrasound-guided dual-target low-temperature plasma ablation for refractory cervicogenic orofacial pain-a report of two cases.

Background: Cervicogenic orofacial pain (COFP) is frequently misdiagnosed or undiagnosed, particularly in patients with refractory orofacial pain. When conventional treatments for conditions such as trigeminal neuralgia, dental pathologies, or oncologic pain fail to provide relief, a cervical spondylotic etiology should be considered. We present two cases of COFP secondary to cervical spondylosis successfully managed with minimally invasive intervention. Case presentation: Both patients present with 3-year histories of unilateral, persistent orofacial pain and dental discomfort. Despite multimodal therapeutic interventions, no significant improvement was observed. Physical examination of the neck and cervical spine MRI both confirmed the diagnosis of cervical spondylosis. After receiving ultrasound-guided low-temperature plasma ablation targeting the C2 dorsal root ganglion and the periarterial region of the vertebral artery V3 segment, both patients experienced immediate and substantial relief from refractory dental and facial pain. Postoperatively, the visual analog scale scores for both patients decreased from 8 to 1. The Jaw Functional Limitation Scale-8 scores improved from 65 to 11 in Patient 1 and from 60 to 8 in Patient 2. Similarly, the Oral Health Impact Profile scores decreased from 45 to 6 in Patient 1 and from 48 to 8 in Patient 2. No recurrence or complications were observed during the 8-month follow-up period. Conclusions: COFP often manifests with subtle symptoms overlapping trigeminal neuralgia and dental disorders, leading to diagnostic delays. Comprehensive neuroanatomical differential diagnosis is critical. Precision-guided minimally invasive cervical interventions can provide effective symptom control, as demonstrated by this dual-target low-temperature plasma ablation approach.