Purpose: To discuss an effective surgical treatment of a subtype of trigeminal neuralgia with descending palatine neuralgia of the maxillary division. Method: Nine patients, who suffered from trigeminal neuralgia with descending palatine neuralgia of the maxillary division, received neurotomy and avulsion of the descending palatine nerve in the pterygopalatine fossa via the greater palatine foramen-pterygopalatine canal approach. Seven of the patients had a recurrence of descending palatine neuralgia after they received treatment of maxillary neuralgia with neurotomy and avulsion of the infraorbital nerve; two patients were diagnosed with descending palatine neuralgia of the maxillary division in our department. Postoperative follow-up was conducted. Results: Pain in the palate disappeared; all patients felt numb and paresthetic in the area innervated by the trigeminal nerve, with no pain. During the 3-36 months of follow-up, no recurrence occurred. Conclusions: Descending palatine neurotomy in the pterygopalatine fossa via the greater palatine foramen-pterygopalatine canal approach is a simple, safe and effective way to treat a subtype of trigeminal neuralgia - descending palatine neuralgia. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.