Ganglionitis of the cervical sympathetic nodes. Damage to the pterygopalatine ganglion (Slader syndrome)

The pterygopalatine ganglion has three main roots: somatic (sensitive) - extending from the second branch trigeminal nerve, parasympathetic - from facial nerve and sympathetic - from the plexus of internal carotid artery(axons of cells of the superior cervical sympathetic ganglion). It also has connections with the ciliary and ear nodes.

The syndrome was first described by Slader in 1908.

Etiology

inflammatory processes in the main and maxillary sinuses, lattice maze,

odontogenic inflammatory processes, tonsillitis,

local injury.

Clinic

Pain when a node is affected resembles neuralgic pain, however, it is necessary to talk not about neuralgia, but about ganglionitis or ganglioneuritis of the pterygopalatine node. The syndrome is characterized by spontaneous sharp pain in the eye, around the orbit in the root of the nose, upper jaw, and sometimes in the teeth and gums of the lower jaw. Pain can spread to the temple, ear, back of the head, neck, shoulder blade, shoulder, forearm and even hand. Cases have been described where the pain spread to the corresponding half of the body. Painful paroxysms are accompanied by pronounced vegetative symptoms - redness of half the face, swelling, hyperhidrosis, conjunctival hyperemia, photophobia, profuse lacrimation and discharge of clear secretion from one half of the nose, hypersalivation, frequent sneezing. Dizziness and nausea may occur. The combination of these symptoms is designated by the term “ vegetative storm" The duration of attacks ranges from several minutes to several hours, sometimes up to 1-2 days. Often attacks of pain develop at night. A number of autonomic disorders persist even after attacks.

One of the important diagnostic signs of damage to the pterygopalatine ganglion is the cessation of the attack after lubricating the posterior parts of the nasal cavity with a 5% solution of cocaine with adrenaline.

The complexity of the clinical symptom complex in Slader syndrome is explained by the fact that pterygopalatine ganglion has numerous connections with various structural formations of the nervous system. Provoking factors can be overwork, anxiety, stress, loud noise, and alcohol consumption.

Treatment.

1. In the acute period, the nasal cavity posterior to the middle turbinate is lubricated with a 3-5% solution of cocaine, ganglion-blocking agents are used: 0.5-1 ml of a 2.5% solution of benzohexonium intramuscularly, a 5% solution of pentamine (starting from 0.4 ml and gradually increasing the dose to 2-3 ml IM). Injections are carried out 2-3 times a day for 3-4 weeks.

2. With pronounced and persistent pain blockade of the node using anesthetics is used. The needle is inserted into the diseased palatine canal through the hole of the same name to a depth of 2.5-3 cm. If no blood appears in the syringe, then 1.5-2 ml of a 2% solution of trimecaine or lidocaine is injected.

3. If there is a symptom of irritation of the parasympathetic department in the clinical picture, anticholinergic drugs are used: platifillin 1-2 ml of 0.2% solution subcutaneously, spasmolitin - 0.1 g 3-4 times a day after meals, metacin tablets 0.002 -0.005 g 2-3 times a day.

Desensitizing therapy (diphenhydramine, suprastin, tavegil).

The use of glucocorticoids orally or phonophoresis of hydrocortisone on the area of projection of the node.

Physiotherapeutic methods: endonasal electrophoresis of 2% novocaine solution, UHF therapy, diadynamic currents; X-ray therapy.

7. After the acute phenomena subside - restorative treatment: vitamins B 1, B 6, B 12, aloe, PHYBS, vitreous. People in the older age group are prescribed vasodilating antisclerotic drugs, as well as drugs that improve cerebral and coronary circulation. All patients are prescribed sedatives.

Ganglionitis is a disease based on inflammation of the ganglion. A ganglion is a nerve ganglion that consists of several components - nerve cells, their bodies, axons and dendrites. Its shell consists of connective tissue. If several such nodes become inflamed at once, then this condition is called polyganglionitis.

Causes

Inflammation of one or more ganglia cannot appear just like that. This is usually caused by other diseases, the most common of which are:

Flu.
Rheumatism.
Malaria.
Angina.
Herpes zoster.
Tumors.
Injuries.
Intoxication of the body.

But most often the cause of this disease is viruses, so according to statistics, it develops against the background of manifestations herpetic infection. If ganglionitis occurs in the area of the pterygopalatine node, then the main causes here can be considered sinusitis, rhinitis in chronic stage, pharyngitis, tonsillitis, purulent otitis.

Manifestations

The symptoms of ganglionitis will depend on its cause. But each species is characterized by such general manifestations, like burning pains that are paroxysmal, and severe itching in the area of the affected area. Paresthesia, which is a tingling or numbness sensation in the skin over the affected ganglion, may also develop.

Inflammation of a herpetic nature is accompanied by a rash of blisters, the touch of which causes pain. The same pain will occur in the area of the spinous processes of the vertebrae if you try to palpate them. Operation may be disrupted internal organs due to defeat nerve ganglia which ensure their uninterrupted operation. The skin above the affected ganglion itself also changes. It changes color, and in more severe cases, ulcers may form on it. The function of thermoregulation and sweating is disrupted, and swelling of the subcutaneous tissue begins. The muscles that are located nearby begin to weaken and lose their tone. Reflexes also decrease, joints become stiff. If the disease affects the cervical ganglia, then the same symptoms begin to appear on the face, neck and different places heads.

With the development of inflammation in the area of the stellate node, pain in the upper half of the chest and false angina may occur.

Ganglionitis of the gasserian ganglion develops due to a decrease in protective forces body. This disease is much more severe than herpetic ganglionitis, and rashes most often occur in the trigeminal nerve area - on the face, near the eyes. In this case, there is a high risk of developing keratitis, that is, inflammation of the cornea. Other symptoms may include photophobia and darkening surface layers skin. The rashes themselves look like small, barely visible dots.

Ganglionitis of the pterygopalatine ganglion is characterized by sharp pains in the eye area and around the orbits, in the area of the upper jaw and root of the nose, less often in the area of the lower jaw. In this case, the pain can spread to the temples and even to the arms.

Inflammation of the geniculate ganglion is characterized by inflammation and herpetic rashes in the ear area and pain. Sometimes there may be complaints of dizziness. When the lumbar and lower thoracic nodes are affected, dysfunction of the pelvic and abdominal organs is observed.

Diagnostics

For diagnosis, only the clinical picture and patient complaints are used. No tests are performed to confirm the diagnosis. Must be carried out differential diagnosis with diseases such as:

Neuritis of the somatic nerve.
Syringomyelia.
Meningoradiculitis.
Neurovascular syndromes.

When diagnosing, consultations with a neurologist, dentist, or ENT specialist are required. Otoscopy and pharyngoscopy may be required, and sometimes x-ray diagnostics are prescribed.

Drug therapy

Treatment for ganglionitis depends on its symptoms and what is causing the disease. Antiallergic and antiviral drugs, as well as immunomodulators that help boost immunity. Treatment must be comprehensive and include taking B vitamins and ganglion blockers, the most effective of which are considered to be ganglerone and pachycarpine.

To treat pain, drugs such as finlepsin, thebantine or catadolone are used. If necessary, treatment can be supplemented with antidepressants.

Novocaine blockades in the affected area help to cope very well with pain. Physiotherapy - ultrasound, Bernard currents - also helps to cope with inflammation. radon baths, sulfuric acid baths, therapeutic mud. However, to achieve a lasting effect, it is imperative to cure the main cause of this disease and certainly improve immunity. This is the only way to get rid of ganglion inflammation forever.

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In the human body there are many nerve nodes called ganglia. They are a concentration of neurons (nerve cells) and their processes with an outer layer of connective tissue. Inflammation of the ganglion in the sympathetic department is called ganglionitis and this pathology manifests itself with various symptoms (pain, itching, etc.), which depend on the cause of the appearance.

Often this pathological process is combined with damage to distant (peripheral) nerve tissues, and in this case the disease is called ganglioneuritis. If the damaged node is localized on the sympathetic trunk and at the same time the root is injured spinal cord, then in medicine this phenomenon is called ganglioradiculitis. Multiple lesions nerve plexuses(polyganglionitis) is rare and requires urgent treatment. The course of therapy should be aimed at eliminating the cause and relieving symptoms.

Ganglionitis develops due to many reasons. Basically they have infectious nature, namely:

Malaria;
Measles;
Scarlet fever;
Sinusitis;
Otitis;
Flu;
Herpes;
Rheumatism;
Oncological diseases;
Injuries;
Angina;
Intoxication.

Most developmental factors are various types of viruses, and the most common culprit is herpes. However, it does not always become the main cause, for example, ganglionitis of the pterygopalatine node develops due to chronic infections such as sinusitis, otitis, etc.

Symptoms

There are quite a few various forms diseases. They are divided according to the reasons for their occurrence, and you can distinguish one type from another by knowing their symptoms:

Herpetic ganglionitis. The main sign of the development of this form is the appearance of painful blisters and pain when palpating the spinous processes of the spine. More often, the patient's thermoregulation is impaired, reflexes and joint mobility are reduced, and swelling occurs. subcutaneous tissue and nearby ones weaken muscle tissue. In rare cases, ulcers develop on the skin directly over the ganglion;
Ganglionitis of the gasserian ganglion. This type of disease is characterized by a rash in the area of the facial nerve, inflammation of the cornea, fear of light and darkening skin, localized above the site of damage. The rashes are usually almost invisible and appear in the form of small dots;
Ganglionitis of the pterygopalatine ganglion. This pathology manifests itself in the form of attacks of severe pain, localized mainly in the head area (face, mouth, back of the head, etc.). Sometimes the disease of the pterygopalatine node gives discomfort hand. The connection of this plexus with the sympathetic department only aggravates the situation and the pain can spread to half the body. Attacks of this form of the disease are usually accompanied by disorders in vegetative department nervous system. Therefore, ganglionitis of the pterygopalatine ganglion affects the appearance of other symptoms, such as tearing and excessive secretion of saliva and mucus from the nose. In rare cases, half of the patient’s face turns red during an attack, and mild residual discomfort remains after the attack. Most often, such seizures are observed in the late afternoon, and their greatest frequency is in the fall and spring. Pathology of the pterygopalatine node can be triggered by the slightest cold, and in some cases patients suffer from this disease for years;
Ganglionitis of the geniculate ganglion. This type of pathology usually manifests itself as a rash localized in the area of the auricle. In my own way appearance it looks like bubbles that cause pain when palpated. Patients have painful sensations in the affected area and dizziness often occurs;

Ganglionitis of the stellate ganglion. This form of the disease is manifested by pain in the chest from the damaged ganglion, so it resembles an attack of angina. Sometimes the pain radiates from the hand and the motor skills of the fingers are impaired;
Upper cervical node disease. This type of lesion is characterized by excessive production of hormones thyroid gland. In people suffering from this form of the disease, the face turns red, sweating increases, metabolism accelerates, and decreases intraocular pressure and the palpebral fissure widens. There is a possibility of developing paresis (weakening) of the muscle tissue of the larynx, which causes a noticeable hoarseness in the voice. Painful sensations can sometimes radiate into the oral cavity, so many patients treat their teeth in the hope of getting rid of the problem;
Lower cervical node. People suffering from this type of illness experience a decrease in tone and reflexes in the upper limb. There have been situations when patients have slight drooping of the auricle on the side of the damaged ganglion;
Ganglioneuritis of the upper thoracic sympathetic nodes. It is characterized by development autonomic disorders and loss of sensitivity in the affected area. This process is accompanied by pain localized in the heart area, breathing problems and rapid heartbeat;
Ganglioneuritis of nodes located in the lower part thoracic and in the lower back. People with this type of disease suffer mainly from pain and trophic changes in the lower half of the body. They experience sensory and vascular disorders in the innervated parts of the body, as well as malfunctions of the abdominal organs;
Sacral ganglioneuritis. Due to this form of the disease, patients have problems with urination and genital function. In women, due to the development of the sacral appearance, the menstrual cycle is often disrupted.

Diagnostics

To diagnose the pathology, it is necessary to differentiate ganglionitis from other similar diseases (syringomyelia, meningoradiculitis, etc.). This can be done, but for this you should consult with other specialists, for example, an ENT specialist, a dentist and a neurologist. After examination, they prescribe pharyngoscopy, fluoroscopy, otoscopy and others instrumental methods examinations to see the cause of the pathology.

Course of therapy

The treatment regimen is drawn up depending on the factor that influenced the development of the disease. It often includes the following:

Antiallergic drugs;
Immunomodulators;
Antiviral medications;
Vitamin complexes, especially group B;
Ganglioblockers of the Pachycarpin type;
Antidepressants.

Additional treatment methods include the following:

Blockade of the ganglion node by injecting novocaine into damaged nerve tissue;
Ultrasound;
Sulfuric acid and radon baths;
Healing mud;
Current Bernard.

Complications

Any pathologies associated with nervous system, leave a mark behind. The main complication of ganglionitis is. It is characterized by a strong burning sensation in the area of damage. It intensifies with palpation and any other contact, for example, with water, a towel, etc. There have been cases when such a complication tormented patients for 2-3 years after the course of therapy.

Sometimes there remains a slight weakening of muscle tissue in the place where the pathology was localized. The consequences can last a lifetime. In the absence of treatment, patients developed zoster myelitis and encephalitis.

Prevention

Preventive measures serve to prevent relapses and speed up recovery period. The methods are extremely effective if combined with compliance healthy image life. A person should get enough sleep and refuse bad habits, exercise and plan your diet correctly.

There are 2 types of prevention:

Primary. It includes methods and procedures aimed at improving immune system to prevent the development of pathology. Best effect shows ultraviolet irradiation and hardening of the body. The first method is prescribed by the attending physician, and before using the second method, consultation with a specialist is required;
Secondary. It consists of physiotherapeutic procedures (UHF, microwave, mud baths, etc.) and traditional methods treatments that are designed to prevent relapses. The duration of the course is determined by the attending physician.

Ganglionitis manifests itself unpleasantly and people suffer from it for a long period of time. If left untreated, this disease can leave behind consequences that depend on its severity and cause. This fate can be avoided by completing a timely course of therapy and following the rules of prevention.

Ganglionitis is an inflammation of the ganglion, the constituent components of which are nerve cell bodies, axons, and dendrites. In this case, the normal functional ability sympathetic column and this is manifested by dysfunction of secretion, pain sensitivity and other important tasks. It should be noted emotional disorders, which greatly influence relationships with other people.

pterygopalatine;
ciliary;
ear;
geniculate;
trigeminal;
submandibular;
sublingual;
star-shaped;
upper cervical

The cause of the disease can be a variety of acute and chronic infections. For example, malaria, brucellosis, syphilis, tonsillitis, influenza, rheumatism, herpes. In addition, trauma, tumors, intoxication, and corticosteroid therapy can be factors for the occurrence of the inflammatory process.

Causes and symptoms

Depending on which ganglion is affected, there will be corresponding clinical manifestations which are described below.

Ganglionitis of the pterygopalatine ganglion (Slader syndrome)

The causes of the pathological condition are arthritis of the temporal mandibular joint, purulent pharyngitis, chronic processes in the sinuses (sinusitis), teeth (caries, periodontitis), tonsils (tonsillitis).

Clinical manifestations are very diverse. This is explained by the fact that the node has individual anatomical features And a large number of anastomoses. The pain is burning, bursting, very intense in half the body (hemitype). Pain can be localized not only in the area where the node itself is located, but also in the following areas: around the orbit, in the eye, the root of the nose, the upper and lower jaw (teeth, gums), temples, auricle, back of the head, shoulder, forearm, hand.

Painful sensations are accompanied by catarrhal syndrome: hyperemia and swelling of the face, lacrimation, rhinorrhea from one nostril, drooling. This condition is more often observed at night, the duration of the paroxysm is from several minutes to several days.

To confirm ganglionitis of the pterygopalatine ganglion, they use the method of lubricating the nasal cavity with a solution of dicaine with adrenaline, after which the pain disappears.

In the periods between attacks, mild signs of vegetative symptoms remain.

Inflammation of the cervical sympathetic nodes

The etiological factors are mainly, chronic infection, intoxication.

Pain sensations radiate (give) to half of the body. Signs: redness, stuffy half of the nose, tissue hypotrophy, a large number of wrinkles, sometimes hyperpigmentation of the corresponding half of the face, hyperemia of the apple, Bern-ra-Horner and Pourfur-de-Petit syndrome.

Causes: tonsillitis, chronic infectious diseases, intoxication.

Most often, patients complain of pain in the cervical-occipital region and shoulder girdle. When palpating pain points in the projection of the node, the exit site occipital nerves, paravertebral region, pain is felt. Accompanied by redness and atrophy of the corresponding half of the face.

Ganglionitis of the upper cervical ganglion

Pathology of the submandibular and sublingual nodes

In this case, the pain is localized in the tongue, submandibular region with irradiation to the lower jaw, neck, back of the head, and temples. The pain intensifies with movements of the lower jaw (eating, talking). The secretion of saliva increases, the tongue and tissues of the submandibular region swell. Anterior part of tongue and mucosa oral cavity characterized by increased sensitivity and hyperpathy. In addition, there will definitely be a lingual-submandibular pain phenomenon.

Ganglionitis of the geniculate ganglion (Ramsay Hunt syndrome)

The herpes virus is the cause of the disease.

The onset of the disease is acute, manifested by general malaise, paresis of the facial nerve, and hearing loss. On the affected side in the ear area there are painful attacks, they can spread to the back of the head, neck, head, face and be neuropathic in nature. In addition, herpetic rashes are observed in the affected areas and on the mucous membrane (soft palate, tonsils). The patient may complain of hearing loss, dizziness, and noise in the ear. On examination there will be horizontal nystagmus and paresis of the facial muscles. Sensitivity is lost on half of the tongue.

Ganglionitis of the Gasserian (trigeminal) ganglion

The disease is caused by a herpes infection, which occurs against the background reduced immunity, especially in older people.

Ganglionitis is characterized by fever, general malaise, intoxication, photophobia, paresthesia, painful and constant pain in the area of innervation of the first, less often the second and third branches. A few days after the onset of pain, a vesicular rash and swelling of the periocular area are observed.

Damage to the ciliary ganglion (Openheim syndrome)

The main causes are sinusitis and the herpes virus.

Characteristic. Paroxysmal pain in the forehead, eye socket, temples, root of the nose and hard palate. Gives a feeling that it's like they're performing eyeballs from orbit. On examination, the mucous membrane of the eyes is red, the eyelids are swollen, profuse lacrimation, Petit and Horner syndrome.

Ganglionitis of the ear ganglion (Frey's syndrome)

Possible causes: mumps, sialadenitis, diseases of the dental system.

Paroxysmal pain with signs of vegetalgia occurs in the area in front of the temporomandibular joint, temples, and ear. Irradiates (gives) to the back of the head, neck, shoulder girdle, arm, top part chest. In this case, the patient complains of noise in the ear (with spasm auditory tube), increased salivation. Subzygomatic blockade of the ear node successfully relieves pain and this makes it possible to diagnose Frey's Syndrome.

Pathology of the stellate ganglion

The pain that occurs is very reminiscent of an angina attack, localized in the upper part of the chest and radiates (gives) to the arms.

Diagnostics

It is sometimes very difficult for doctors to diagnose accurate diagnosis. Consultation with a neurologist, dentist, or ENT specialist is necessary.

Diagnostics is based on clinical data:

severe and paroxysmal pain that resembles the sensation of a burn;
itching of the affected area;
paresthesia, anesthesia;
swelling;
hyperemia;
amyotrophy;
increased sensitivity;
innervation disorder (pilomotor, secretory, vasomotor, trophic);
catarrhal syndrome;
local and general increase in temperature;
malaise.

Upon examination, there will be pain on palpation of the pain points of the projection of the node itself and its nerves, and impaired sensitivity.

Sometimes used additional methods diagnostics: otoscopy, pharyngoscopy, radiography.

How is ganglionitis diagnosed?

Differential diagnosis carried out with diseases such as syringomyelia, meningoradiculitis, neurovascular syndrome, neuritis of the somatic nerves, diseases of the heart and abdominal organs.

Treatment of ganglionitis

Therapy depends on the cause that led to pathological condition. Doctors prescribe methods of therapy that are suitable for specific case and depending on general condition sick.

Physiotherapy methods are used: ultrasound therapy, ionogalvanization, phonophoresis, Bernard currents, UV irradiation, electrophoresis, laser therapy.

In addition, low-temperature therapeutic mud, baths (radon, salt, hydrogen sulfide), and ozokerite applications are used.

Drug therapy includes the prescription of the following drugs:

analgesics (sedalgin, indomethacin) – to relieve pain syndrome;
antibiotics, sulfa drugs(in a process caused by bacteria);
antiviral - in the presence of herpes infection (acyclovir);
ganglion blockers - to reduce the excitability of vegetative formations;
desensitizing agents (suprastin, diphenhydramine);
injections of glucocorticosteroids into the area of projection of the node (hydrocortisone);
antispasmodics (papaverine);
biogenic stimulants and immunomodulators to improve immunity (echinacea extract, aloe);
neuroleptics, antidepressants (aminazine, tizercin);
nootropic drugs to improve cerebral circulation(mainly for older people);
B vitamins (cyanocobolamine, B6);
anticholinergic drugs (platifillin, metacin) - if the symptoms of the parasympathetic system are pronounced;
novocaine blockade of the node;
applications of a 25% solution of dimexide with 10% novocaine.

If medication and physiotherapeutic methods are ineffective or contraindicated, then it is recommended surgical intervention. To do this, they carry out novocaine blockade of the node or destroy it through alcoholization. In addition, surgery is indicated when the ganglion is affected by a tumor.

Forecast

In most cases, patients recover. But sometimes there may be subsequent complications: trophic changes in the area of nerve innervation, causalgic pain, muscle paresis, encephalitis, Guillain-Barré syndrome, meningitis. During the disease, the ability to work is significantly reduced, especially when the pathological process lasts for a long time.

Prevention

First of all, it is necessary to treat chronic diseases, since they are the main cause of ganglionitis. The second task is to strengthen the immune system. To do this you need to eat right, exercise physical culture, refrain from stressful situations. Immunostimulants can be used. In addition, it is necessary to avoid hypothermia and injury.

To treat ganglionitis, you must first understand and find out etiological factor. There are many treatment options, it all depends on the affected ganglion, the patient’s condition, concomitant diseases, contraindications. The prognosis with high-quality treatment is quite favorable.

Pterygopalatine ganglionitis is a pathology of the pterygopalatine ganglion, one of the varieties of vegetative ganglionitis and dental syndromes. It also occurs under the name Slunder syndrome (on behalf of the American otolaryngologist who first described the disease). Another name is neuralgia of the pterygopalatine ganglion. The difficulty is that clinical picture very extensive. Most often, ganglionitis of the pterygopalatine ganglion manifests itself with facial pain (paroxysmal) and disorders of the autonomic system.

The pterygopalatine ganglion (node) is located in the pterygopalatine fossa and is formed from a branch of the trigeminal nerve. Consists of three roots:

somatic (trigeminal nerve);
parasimatic (facial nerve);
sympathetic (plexus of the carotid artery, connected with the ear, cervical nodes, nerve endings of the skull).

Causes of ganglionitis of the pterygopalatine ganglion

The pterygopalatine ganglion may be affected due to inflammatory processes in the sinuses of the upper or lower jaw (osteomyelitis), the ethmoid labyrinth of the paranasal sinuses. Reasons of this disease There may also be toxic effects from tonsillitis, local damage (for example, foreign damage to the nose or its mucous membrane), the harmful effects of caries, purulent otitis.

Any infectious foci in the oral cavity can become serious provocateurs of this disease. Provocateurs for the excitation of the disease are overwork or lack of sleep, loud annoying sounds constant nature, stress, alcohol abuse or smoking.

Inflammation of the pterygopalatine node can also be caused by maxillary tumors, both benign and malignant.

Symptoms of ganglionitis of the pterygopalatine ganglion

The disease progresses long time(months or years), severe exacerbations periodically occur (especially in the autumn-spring period, when the immune system is weakened, after stress or excitement).

One of the first symptoms will be paroxysmal strong pain half of the face, which is accompanied by burning, lumbago. Mostly painful sensations occur in the eye, behind the eye, in the teeth, in the upper and lower jaws, in the bridge of the nose, tongue and palate. The pain syndrome can spread to the occipital area, parotid region, ear, neck, forearm, shoulder blades, even to the fingertips and hand area. The most painful sensations occur in the area of the bridge of the nose and mastoid process. Depending on the severity and duration of the disease, pain may be present for several hours, days or even weeks. Exacerbation of pain syndrome often occurs at night. Patients report sensations of tickling in the nose, sneezing, runny nose, active salivation, sweating, dizziness, nausea, and watery eyes.

A characteristic symptom of this disease is the so-called “vegetative storm”, which manifests itself in the form of swelling and redness of the face, profuse lacrimation and salivation, and shortness of breath. Moreover, saliva is often released so much that it involuntarily flows out of the patient’s mouth. The person is forced to use a towel. Sometimes there is an increase in temperature and secretion from the nose. In some cases, disorders may occur taste buds, asthma-like attacks. At the peak of attacks, the eyes become very sensitive not only to bright light, but also to lighting in general, swelling occurs upper eyelid, sometimes intraocular pressure increases and exophthalmos occurs. Often pain points are identified in the inner part of the corner of the eye, the root of the nose. In some cases, paresis of the muscle that raises the soft palate occurs.

Diagnosis of ganglionitis of the pterygopalatine ganglion

This disease is not easy to diagnose due to its similar clinical picture to other pathologies. For example, similar symptoms are observed in nasociliary nerve syndrome, Sicard syndrome, Charlin syndrome, migraine and temporal arteritis.

It is important to distinguish ganglionitis of the pterygopalatine ganglion from various types facial neuralgia, in which shooting pain is also observed, but is not accompanied by nausea or vomiting. Changes in the mucous membrane of the paranasal sinuses are very similar to the clinical picture of rhinitis and sinusitis. To exclude these diseases, turundas soaked in a weak solution of cocaine, dicaine or novocaine are introduced into the nasal passages. A change in the nature of pain, its reduction, and partial normalization of autonomic functions can confirm the diagnosis of ganglionitis of the pterygopalatine ganglion.

The difficulty of diagnosing this disease is explained primarily by the fact that the pterygopalatine ganglion is associated with many nerve structures, which, when inflamed or excited, can produce the most various symptoms. When diagnosing this disease, the patient needs to consult several doctors, in addition to a neurologist - otolaryngologist and dentist.

Treatment of ganglionitis of the pterygopalatine ganglion

The first task of a neurologist in treating this disease will be to eliminate the inflammatory process in the nose, its paranasal sinuses, oral cavity, in teeth. For this purpose, anti-inflammatory, ganglion blocking agents are used. This is 1 ml of a 2.5% benzohexonium solution intramuscularly, 5% pentamine. Injections are given three times a day for a month.
After pain syndromes are eliminated, medications are prescribed to generally strengthen the patient’s body, for example, vitamins B1, B6, B12, aloe, vitreous (immunotherapy). Sedatives are also required.
To relieve severe pain, if conservative therapy is ineffective, the anesthetics trimecaine or lycocaine are used. In this case, the injection is made directly into the palatine canal. If the clinical picture shows parasympathetic symptoms, attributed to platifilin, antispasmodic. In some cases, the use of glucocorticoids or hydrocortisone phonophoresis is prescribed (physiotherapeutic treatment options).
If the disease develops as a result of inflammatory processes, then anti-infective therapy is used in the form of antibiotics or sulfonamides. The background of treatment is desensitizing drugs (diphenhydramine, pipolfen).
To improve the patient’s general well-being, vasodilating antisclerotic drugs are prescribed, and injections are given to improve cerebral and general circulation.
In severe cases of the disease it is used radical treatment in the form of direct destruction of the pterygopalatine node.

This can be done in one of two ways:

Puncture of the pterygopalatine canal from the oral cavity. This method is complex in execution technique and may have severe consequences for the patient;
Puncture of the pterygopalatine node in the pterygopalatine fossa with access from under the zygomatic arch. With this method, a solution of phenol in glycerin and concentrated alcohol solution (96%).

Relapses of the disease do not always disappear as a result of treatment, but the clinical picture changes significantly. Many symptoms disappear or appear much less frequently. Treatment must be comprehensive, adequate and timely, only in this case a positive result is possible.