You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
mandibular nerve block is commonly used for diagnosis and treatment of trigeminal neuralgia involving the mandibular division .
neurolytic blockade with absolute alcohol / phenol is usually required after diagnostic block to provide long term pain relief .
common complications of this block are hypoesthesia , dysesthesia , chemical neuritis , sensory loss in mandibular nerve distribution and very rarely facial and occulomotor palsy and masseter muscle weakness leading to difficulty in chewing .
we report a rare complication in a patient with mandibular neuralgia , who developed prolonged severe vertigo and ataxia after neurolytic blockade of mandibular nerve with absolute alcohol .
a 65 year old male patient presented to our pain clinic with complaint of right sided facial pain for the last 2 years . the pain was excruciating and confined to right lower jaw .
he was diagnosed as a case of right sided trigeminal neuralgia involving the mandibular division ( v3 ) .
he was on regular medication with oral carbamazepine 200 mg three times daily and gabapentin 300 mg twice daily .
his symptoms had worsened in last few days and the pain became refractory to treatment .
clinical examination revealed pulse rate 70/minute and blood pressure of 140/90 mmhg . as the pain distribution was in the mandibular division , involving whole right lower jaw up to ear , neurolytic block of the right mandibular nerve was planned .
the patient was placed in supine position with head tilted to left - side . after aseptic preparation and draping of the part , skin and subcutaneous tissue was infiltrated with 3 ml of 2% lignocaine .
a 9.0 cm 22 gauge ( g ) needle was introduced perpendicularly in the middle of coronal process at midpoint of inferior border of right zygomatic arch .
the needle was withdrawn slightly and directed posteriorly towards the ear so that it passed the posterior border of the pterygoid plate .
the needle was then carefully advanced 0.5 cm each time till the patient reported paresthesia over mandibular region .
after negative aspiration of blood , diagnostic block with 3 ml of 2% lignocaine was given .
five minutes after eliciting hypoesthesia in mandibular distribution , 1 ml of absolute alcohol ( aa ) was given for the neurolytic block .
after about 5 minutes of the block , when the patient was allowed to sit up , he complained of severe giddiness ( vertigo ) and was not able to sit and stand up .
vertigo was associated with severe nausea and vomiting , however , patient`s hearing and speech was normal .
the patient was immediately placed in supine position and vital examination revealed pulse rate of 60/minutes and blood pressure of 210/110 mmhg .
the patient was given 500 ml of intravenous fluid ( dextrose /saline ) with 8 mg ondansetron intravenous and 10 mg nifedipine sublingually for treating vomiting and hypertension , respectively .
after 30 minutes , the patient was reassessed and was found to have severe vertigo while sitting , and ataxia while walking .
his blood pressure had decreased to 170/90 mmhg and his nausea and vomiting stopped . in view of persistent vertigo and ataxia ,
complete neurological evaluation was performed however , no significant abnormality was found except for vertigo and ataxia with tendency to fall on right side . it was decided to admit the patient in the ward for further investigation , observation and management . computerized tomography ( ct ) scan brain
was performed to rule out any central cause of ataxia , which was found to be normal .
patient slept well in the night and was reassessed the next morning . by this time ,
patient had improved significantly and was not having vertigo , ataxia or nausea and vomiting . as the patient`s vertigo and ataxia had significantly improved and he was able to walk normally , he was discharged from the hospital with advice to come for regular follow - up after one week .
the patient was found to be pain free with slight hypesthesia in the right mandibular distribution .
usual complications of mandibular nerve block are hypoesthesia , dysesthesia , sensory loss in mandibular nerve distribution , facial swelling and masseter muscle weakness .
accidental injuries to the auditory tube while trying to locate or block the mandibular nerve are possible , as it is in close proximity .
if this occurs during or after the test injection following local anesthetic , one should defer the injection of neurolytic agent .
diagnostic test injection with 3 ml of 2% lignocaine was uneventful and there was no resistance to injection or symptom of auditory tube irritation , i.e. pain in ear , deafness etc .
patient developed severe vertigo and ataxia five minutes after the aa injection when he was allowed to sit - up , stand and walk .
he also developed hypertension ( blood pressure-210/110 mmhg ) and two episodes of severe nausea and vomiting .
reported the first and only case report of vertigo during mandibular nerve block with aa .
they attributed this to multiple factors : firstly their patient had received multiple neurolytic blocks before , which probably had resulted in tissue inflammation and adhesion formation ; secondly , the patient had pain in the ear during the advancement of the needle and there was high resistance to aa injection , indicating injury to auditory tube ; and lastly , their patient also developed prolonged horizontal nystagmus along with vertigo .
the clinical manifestations in our patient were however different as he had not received any neurolytic block before , had no pain during injection and there was no resistance during injection of either lignocaine or aa .
we used a 22 g , 9 cm sharp tip spinal needle for the block , due to the non availability of blunt tip needle .
we may have inadvertently injured the cartilaginous part of auditory tube with the block needle and a small amount of aa might have entered the auditory canal and reached the vestibular apparatus resulting in vertigo and ataxia . in patients who receive repeated neurolytic mandibular nerve blocks , abnormal degeneration in the tissues surrounding the nerve should be considered and all agents should be injected precisely and slowly . whenever there is a suspicion of injury to auditory canal , it is advisable to defer neurolytic blockade with aa . patients should be closely observed for at least an hour after the block when aa is used because stimulation of the vestibular apparatus may be delayed . in the case
reported , we did not observe any pain or resistance to injection to lignocaine or alcohol which may have alarmed us about the complication .
vertebro basilar ischemia or posterior circulation stroke may present as vertigo , ataxia , diplopia , dysartheria and weakness of one or both side of body .
our patient was 65 years old and developed vertigo , ataxia and hypertension after the neurolytic mandibular block .
our patient did not have nystagmus , diplopia , and dysartheria and was not a known hypertensive .
features favoring vestibular ataxia , and not the central cerebellar ataxia included : presence of severe vertigo , associated with body movement ; presence of severe nausea and vomiting ; severe ataxia with tendency to fall toward affected side ; and increase in imbalance while walking with closed eyes .
neurology consultation was taken and ct scan brain was performed to rule out any possibility of stroke which was found to be normal .
we have presented a patient of trigeminal neuralgia , who developed prolonged severe vertigo , ataxia and hypertension after the mandibular nerve block with aa , which gradually improved over 24 hours .
we emphasize that in trigeminal neuralgia patients , who usually require repeated neurolytic mandibular block , the possibility of severe vertigo and ataxia should be kept in mind , as it may be associated with increased risk and complications , requiring prolonged observation and management .
use of guided techniques ( nerve locator , fluoroscopy , ultrasound or ct guidance ) can be considered in some selected patients .
common complications of neurolytic mandibular nerve block are hypoesthesia , dysesthesia , and chemical neuritis . 
 we report a rare complication , prolonged severe vertigo and ataxia , after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia . 
 coronoid approach was used for right sided mandibular block . after successful test injection with local anesthetic , 
 absolute alcohol was given for neurolytic block . 
 immediately after alcohol injection , patient developed nausea and vomiting along with severe vertigo , ataxia and hypertension . neurological evaluation was normal except for the presence of vertigo and ataxia . 
 computerised tomography scan brain was also normal . 
 patient was admitted for observation and symptomatic treatment was given . 
 vertigo and ataxia gradually improved over 24 hours .