Ganglionitis of the cervical sympathetic nodes. Ganglionitis - the essence of the disease and methods of treatment

Many people are interested in what it is - ganglionitis. This is a disease based on inflammation of the ganglion. This is the name for a nerve cell consisting of nerve cells, their bodies, axons and dendrites. Its shell is made up of connective tissue. If two such nodes become inflamed at once, this condition is called polyganglionitis.

After identifying the symptoms, diagnosing and treating ganglionitis, they begin to use medications and undergo physical procedures.

Causes

The most common cause of the development of ganglionitis is the penetration of infection, resulting in the beginning of an inflammatory process. The source of infection is local inflammatory diseases of the nasopharynx:

sinusitis, chronic rhinitis, pharyngitis;
less often - arthritis

Ganglionitis can occur as a result of toxic effects on the nerve ganglion during purulent otitis media. Factors contributing to the occurrence of ganglionitis of the pterygopalatine ganglion are lack of sleep, overwork, stressful situations, alcohol intake, and loud noise.

Symptoms

Often, the symptoms of ganglionitis depend on the specific cause of the disease. Despite this, there are several common manifestations that occur in many patients: burning pain and unpleasant itching. Patients often develop paresthesia - numbness and tingling of the skin in the area of the inflamed ganglion. If the inflammation is diagnosed as herpetic, blisters appear on the skin, painful when touched. In the area of the spinous processes of the vertebrae, pain may also occur on palpation. The skin in the affected area changes color as well as texture.

Ulcers

Ganglionitis is easy to identify in the most difficult cases of the disease, when ulcers appear on the affected area of the skin, and internal organs lose their functionality due to damage to the nerve nodes. Muscles located in the area of inflammation also undergo degeneration. They weaken and lose their tone. The joints lose their mobility, which is why the patient's reflex speed is reduced. Patients often complain of heart problems and angina, but this is caused by inflammation in the area of the stellate ganglion, which creates false secondary complaints.

Kinds

Ganglionitis is an inflammatory process occurring in the ganglion. The etiology of this disease is quite extensive - from lesions due to viral infections to post-traumatic inflammation.

The specific symptomatic differences of ganglionitis depend on the localization of the inflammatory process, while the general signs of this disease are: swelling of the affected area, itching, pain.

When considering the types of ganglionitis, you should focus on the following diagnostic features:

When ganglionitis is localized in the area of the sternum and upper shoulder girdle, the so-called stellate ganglion is affected. The symptoms and treatment of stellate ganglionitis are very varied and often misleading when making a diagnosis. In this case, the patient may complain of heart pain; after a detailed examination, false angina can be diagnosed.
When the disease is localized in the area of the eyeball, inflammation affects the Gasserian node, and symptoms of keratitis, photophobia, swelling in the eye area, and rash are noted. This type of ganglionitis may result from a herpes infection.
upper respiratory tract, auditory system and oral cavity (tonsillitis, sinusitis, pharyngitis, otitis, pulpitis and caries) can provoke ganglionitis in the pterygopalatine node, located in one of the maxillary sinuses. This localization is characterized by pain in almost all parts of the face and head (touching the ears, eye sockets, tip of the nose, temples is painful, sometimes pain even extends to the area of the upper shoulder girdle).
A separate type of ganglionitis includes Ramsay-Hunt syndrome, when the lesion is localized in the area of the auricle. It is a consequence of herpetic infection. Symptoms of this type include ear pain and dizziness. It differs from the previous lesion of the pterygopalatine ganglion in the manifestation of paresis of the facial nerve.
The symptoms and treatment of cervical ganglionitis are determined by the doctor. As a rule, the disease is a consequence of cervical osteochondrosis; in addition, it can be caused by any of the infections or develop against the background of the clinical picture of tonsillitis. Pain in this type is localized in the area of the shoulder girdle and the back of the head. In addition, additional symptoms of ganglionitis affecting the cervical ganglion may include redness of the face and eyes, asymmetrical appearance of wrinkles on one side of the face, and difficulty breathing due to nasal congestion.
Pain directly in the tongue, which then moves to the jaw and further to the temples, neck and back of the head - these are symptoms of ganglionitis of the pterygopalatine ganglion. Treatment and additional diagnostics in this case are prescribed by a specialized specialist. In addition, salivation increases, the soft tissues of the tongue become hypersensitive, and it is painful for the patient to move the jaws.
Ciliary ganglionitis (or Oppenheim syndrome) develops against the background of a herpes infection or as a consequence of chronic, untreated sinusitis. Characteristic symptoms for this lesion include lacrimation and localized pain in the area of the eye sockets and temples.
There is also herpetic ganglionitis (symptoms and treatment will be determined by a specialist). It is necessary to note the characteristic rash and pain along the nerve endings of the spine.

Diagnostics

The diagnosis of the disease is based on the collection of complaints, medical history, clinical manifestations, and instrumental diagnostics.

Patient complaints are varied and depend on the location of the inflammation. The most common concerns are acute paroxysmal pain, swelling and itching of the affected area, increased body temperature, excessive sweating, weakness, loss of strength, and limited movement in the joints.

A survey of the disease history will allow you to establish the cause and begin timely and correct treatment. The patient's body temperature, skin and mucous membranes are objectively assessed, and the affected area is thoroughly examined.

When palpating the projection points of the node, pain and impaired sensitivity are detected. There are no specific tests that can accurately diagnose ganglionitis.

Related diseases

The disease must be differentiated from meningoradiculitis, neuritis, syringomyelia, and neurovascular syndromes. For this purpose, the patient is referred for consultation to a neurologist, ENT doctor and dentist. Pharyngoscopy (examination of the pharynx) and otoscopy (examination of the ear) are used as instrumental research methods. X-ray diagnostics are possible.

After the final identification of symptoms of ganglionitis of the stellate ganglion, treatment is prescribed immediately.

Treatment

Many patients are interested in how to treat ganglionitis. Symptoms and treatment of the disease will depend directly on the degree and severity, localization of the inflammatory process. Drug treatment, physiotherapy, and less commonly surgery are widely used.

Medicinal substances

As already mentioned, the symptoms and treatment of ganglionitis (photos of people suffering from this unpleasant disease are presented in the article) depend on the type of disease. Therapy is purely individual. But everything will come down to physical therapy and medication. The operation requires certain actions; each doctor decides this issue, based on the individual characteristics of each person.

To cure this disease, you will have to undergo a certain course of medications. Namely:

Taking Interferon. The body needs antibacterial and antiviral support.
Treatment with drugs with desensitizing properties. These include "Diazolin", "Tavegil", "Ketotifen".
The course of treatment also involves taking analgesics (Analgin, Indomethacin, Diclofenac).
Ganglioblockers will be required. For example, "Gangleron" or "Pentalgin".
It would not be superfluous to use vasodilators (Nikoshpan, Thionikol, Papaverine).
At some stages, antihypoxants will be required: “Aevit”, “Sodium oxybutyrate”.
For better metabolism in tissues and activation of reparative and regenerative processes, Pentoxyl and Petiluracil are suitable. The use of immunomodulators is vital.

Physiotherapy

Any physiotherapy will be aimed at solving a whole range of problems. With ganglionitis, the pain syndrome must first be relieved. The methods used are anesthetic. The problem of intoxication and inflammation needs to be solved. Antimicrobial and antiviral therapy will help here. For inflammatory processes, the anti-exudative method of physiotherapy will help. Any allergic reactions that occur will be eliminated in any available way. To normalize all functions of the peripheral nervous system, they will resort to a method in which all free nerve endings will be irritated. For dystrophy, the trophostimulating method is used. To correct immune dysfunction, immunostimulating physiotherapy will be chosen.

Spa treatment

Sometimes patients are sent simply to rest in a sanatorium. This is done during the final period, when the disease is especially acute. It is carried out only in the complete absence of pronounced disorders of the nervous system and pain. Absolutely any resort is suitable. It doesn't matter if it's mud baths or rocky beaches. The only important thing is the process in which a person gives rest to the nervous system of the body and puts himself in order. It is worth noting that this best happens near the sea due to the salty air.

Prevention

The basis for the prevention of ganglionitis includes timely and correct treatment, prevention of the development of viral diseases.

You should lead a healthy lifestyle and give up bad habits, do not eat a lot of fatty and salty foods.
Every day you need to exercise. Morning jogging will not be superfluous either.
Hardening strengthens the immune system well, but don’t immediately douse yourself with ice water. You need to start gradually with light douches in the bath, with rubbing your limbs with a cold and wet towel, and then you can gradually move on to douches in the fresh air, but first only in the warm season.
Don't forget about a hat during the cold season. After all, no hairstyle can be more valuable than your own health, and without a hat in winter you can get sick with more serious diseases.
To prevent the disease, especially in spring and autumn, you need to strengthen your immune system with vitamins and eat more fruits and vegetables.

It is also important to get vaccinated in advance; it will provide the body with lasting immunity against this disease. During a disease outbreak, you must wear a special protective mask.

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 of the sympathetic column is disrupted and this is manifested by dysfunction of secretion, pain sensitivity and other important tasks. It is impossible not to note emotional disorders that greatly affect 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 for each person. 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 and 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 point of the occipital nerves, the 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. The anterior part of the tongue and the oral mucosa are 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. Pain attacks occur on the affected side in the ear area; 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 of reduced immunity, especially in older people.

Ganglionitis is characterized by increased temperature, 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. It causes a sensation as if the eyeballs are protruding from the 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, upper chest. In this case, the patient complains of noise in the ear (with spasm of the 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 make an 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 additional diagnostic methods are used: otoscopy, pharyngoscopy, radiography.

How is ganglionitis diagnosed?

Differential diagnosis is 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 the pathological condition. Doctors prescribe methods of therapy that are suitable in a particular case and depending on the general condition of the patient.

Physiotherapy methods include: 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;
antibiotics, sulfa drugs (for processes 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 surgical intervention is recommended. 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, and avoid stressful situations. Immunostimulants can be used. In addition, it is necessary to avoid hypothermia and injury.

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

Ganglioneuritis is an inflammation of the ganglion (nerve ganglion), which is accompanied by damage to the sympathetic, parasympathetic or sensory nerve fibers related to it.

Causes

The main reason for the development of ganglioneuritis is an acute or chronic infectious process in the body, which can be caused by streptococci, staphylococci, herpes viruses and other pathogens.

The pathological process from the primary focus spreads to nearby nerve nodes. Depending on which ganglia are inflamed, several types of disease are distinguished: cervical, thoracic, lumbar, sacral ganglioneuritis. In addition, the diagnosis may contain the name of the affected node (for example, pterygopalatine ganglioneuritis, pelvic plexus ganglioneuritis) or indicate the etiology of the disease (staphylococcal, herpetic, postherpetic ganglioneuritis).

Inflammation of the ganglion can lead to:

chronic pathologies - complicated caries (ganglioneuritis of the pterygopalatine ganglion), adnexitis, salpingitis, oophoritis, prostatitis (sacral, pelvic ganglioneuritis);
acute diseases - diphtheria, influenza, erysipelas, tonsillitis, scarlet fever.

In rare cases, the pathology is associated with a toxic effect on the body or a tumor process (ganglioneuroma, metastases).

Factors contributing to damage to nerve ganglia:

overwork;
hypothermia;
stress;
alcoholism;
surgical interventions near the ganglia.

Symptoms

The main symptom of ganglioneuritis is diffuse pain, which has a burning character and is accompanied by a feeling of pulsation (bloating). The localization of discomfort depends on the location of the node. In some cases, they spread to the entire half of the body or the opposite side. The pain does not intensify with movement, but can become more intense with changes in weather, stress, and eating.

In addition, inflammation of the ganglion is complemented by:

sensitivity disorder - its decrease (hypoesthesia), increase (hyperesthesia) or paresthesia (numbness, tingling);
neurotrophic and vasomotor disorders in the area of innervation of the affected node;
emotional instability, sleep disturbance (with a long course).

Specific symptoms of the disease depend on the location of the inflamed ganglion and the etiological factor.

Symptoms of pelvic and sacral ganglioneuritis in women:

discomfort during sexual intercourse;
aching pain in the lower abdomen, radiating to the perineum and rectum;
menstrual irregularities, uterine bleeding.

As a rule, pelvic ganglioneuritis is caused by a herpetic infection, so its symptoms can be supplemented by an itchy rash in the form of blisters over the lower back, sacrum, and in the perineal area.

Cervical ganglioneuritis can be upper cervical, lower cervical and stellate. Manifestations of upper cervical inflammation:

expansion of the palpebral fissure;
hyperthyroidism due to stimulation of the thyroid gland;
redness of half the face;
change in sensitivity above the second rib;
laryngeal paresis, hoarseness;
toothache (in some cases).

Ganglioneuritis of the lower sternum and lower back is accompanied by:

unpleasant sensations and sensitivity disorders in the lower torso and limbs;
severe pain in the thigh (with involvement of the sciatic nerve);
vegetative-visceral disorders of the abdominal organs.

Other possible manifestations of ganglion inflammation:

ganglioneuritis of the pterygopalatine ganglion - shooting pain in the orbit and upper jaw, redness of half the face, lacrimation from one eye, copious discharge from one nasal passage;
damage to the geniculate node - pain in the ear, radiating to the back of the head and neck, paresis of facial muscles.

Diagnostics

Inflammation of the nerve ganglion is diagnosed by a neurologist based on:

patient complaints of pain;
vasomotor and neurotrophic disorders;
sensitivity disorders;
other specific symptoms.

In addition, instrumental methods are used:

radiography of the spine;
electromyography;
Ultrasound of the abdominal and pelvic organs;
Ultrasound of the prostate and others.

To identify the causative agent of the infectious process, serological studies are carried out.

Since the pain syndrome due to inflammation of the nerve ganglion is nonspecific, many patients mistake the symptoms of pelvic postherpetic ganglioneuritis for gynecological pathology and seek treatment from.

Ganglion damage is differentiated from funicular myelosis, spinal tumor, neurosis, and so on.

Treatment

The treatment algorithm for ganglionveuritis is determined by its causes. Etiological therapy is aimed at stopping the inflammatory process. For example, for the treatment of viral pelvic ganglioneuritis of herpetic origin, antiviral drugs are prescribed - Zovirax, acyclovir. If the pathology is caused by a bacterial infection, antibiotics are used.

General directions for the treatment of ganglioneuritis of the lower sternum and other areas:

analgesics, including intravenous novocaine and blockade in the affected area;
ganglion blockers, anticholinergics, neuroleptics, antispasmodics - in case of increased activity of the sympathetic nervous system;
calcium gluconate, calcium chloride, cholinomimetics - with a decrease in the activity of the sympathetic nervous system;
physiotherapy - ultraviolet irradiation, electrophoresis (with ganglerone, potassium iodide, novocaine), radon baths, mud applications.

If conservative therapy is ineffective, sympathectomy is performed - removal of the affected area of the autonomic nervous system. Depending on the location of the inflamed ganglion, it can be thoracic, lumbar, and so on. As a rule, interventions are carried out in a minimally invasive way - through laparoscopic or thoracoscopy.

Forecast

Ganglioneuritis has a favorable prognosis for life provided adequate treatment. In many cases, therapy continues for a long time, and the patient’s ability to work decreases.

Prevention

The main measures to prevent inflammation of the nerve nodes are timely treatment of infectious diseases and strengthening the immune system.

Found a mistake? Select it and click Ctrl + Enter

print version

Ganglionitis (ganglioneuritis) of the pterygopalatine ganglion one of the neurodental syndromes. This symptom complex is characterized by significant variability in clinical manifestations. The node has three main roots: somatic (sensitive) - from the second branch of the trigeminal nerve, parasympathetic - from the facial nerve and sympathetic - from the plexus of the internal carotid artery; the latter also has connections with the ciliary, auricular, upper cervical sympathetic nodes and cranial nerves, especially with the trigeminal and facial.

Etiology and pathogenesis. The pterygopalatine node is affected by inflammatory processes in the main and maxillary sinuses, the ethmoidal labyrinth, since the node is closest to the upper or lower jaw. Toxic effects from tonsillitis, complicated caries and local trauma can cause the disease. Provoking factors are overwork, lack of sleep, loud noise, excitement, alcohol consumption, smoking.

Clinical picture . Neuralgia of the pterygopalatine ganglion (Slader 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, auricle, back of the head, neck, shoulder blade, shoulder, forearm and even hand. Painful paroxysms are accompanied by pronounced vegetative symptoms, a kind of “vegetative storm” (redness of half the face, swelling of the facial tissues, lacrimation, copious discharge of secretions from one half of the nose). The attack lasts from several minutes to several hours, and sometimes 1-2 days. and more. Often painful paroxysms develop at night. 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 solution of cocaine and adrenaline.

The illness continues for months and even years. After an attack, a number of vegetative symptoms remain mild. The variety of clinical manifestations of damage to the pterygopalatine ganglion is explained by its individual anatomical features and numerous anastomoses with various nerve formations of the face and other areas.

Treatment. In the acute period, the nasal cavity posterior to the middle turbinate is lubricated with a 3-5% cocaine solution. Novocaine is also used: cotton swabs moistened with a 2% novocaine solution are inserted into the nasal cavity. For severe pain, ganglion blockers (benzohexonium, pentamine) are prescribed. In severe cases, they resort to blocking the node using anesthetics. Treatment must be comprehensive. If the syndrome develops against the background of inflammatory processes in the paranasal sinuses, face, mouth and jaws, then anti-infective therapy (antibiotics, sulfonamides) is necessary. Treatment should be carried out against the background of desensitizing drugs (diphenhydramine, suprastin, pipolfen). A good therapeutic effect is achieved with hydrocortisone injections into the area of the node projection. Pachycarpine, antispasmodics, and antipsychotics are prescribed in combination with antidepressants. If the clinical picture is dominated by symptoms of irritation of the parasympathetic part, then anticholinergic drugs are used (platiphylline, antispasmodic, belladonna preparations, metacin, aprofen).

Endonasal electrophoresis of a 2% novocaine solution, UHF therapy, and diadynamic currents are used. After the acute phenomena have subsided, mud applications at low temperatures (36-37°C) are used on the affected side or in the form of a collar. Perform a light massage of the neck and face muscles. B vitamins and biogenic stimulants (aloe extract, PHYBS, vitreous) are indicated. Elderly and senile people are prescribed anti-sclerotic drugs, as well as drugs that improve cerebral and coronary circulation. In severe forms, they resort to blockade of the node using a 2% trimecaine solution or alcoholization. Node destruction is rarely used. The treatment provided does not always relieve patients from relapses of the disease, but the severity of clinical manifestations is significantly reduced.

Pterygopalatine neuralgia, as we have already written, is also called ganglionitis pterygopalatine node, which indicates an inflammatory component of neuralgia - since all inflammatory diagnoses have the ending “-itis”. Ganglionitis is a disease that is dealt with first by dentists and then by neurologists, and the manifestations of the disease are combined into one “neurostomatological” syndrome.

Cranial nerves - pterygopalatine ganglion

Ganglionitis was discovered by an American doctor and is called Slader's syndrome(Slyudera). This syndrome was described quite late - in 1908, only when such sciences as neurology, physiology of the central and peripheral nervous system, as well as the art of dissection were highly developed.

Ganglion structure

The pterygopalatine ganglion lies “at the junction” of many “roads” of the peripheral nervous system. This determines the variability of clinical manifestations. It has the following parts:

Sensitive somatic fibers from the maxillary nerve, carrying innervation from the oral mucosa, gums, cheeks;
From the facial nerve - parasympathetic fibers that affect secretion and taste;
From the carotid plexus - the internal carotid artery - sympathetic fibers.

In addition to these parts, which connect the ganglion with the facial and trigeminal nerve systems, the pterygopalatine ganglion is connected to a significant extent with the sympathetic ganglia and other ganglia, for example, the auricular and ciliary ganglia.

Such a close relationship allows the pterygopalatine node to respond sensitively to all processes occurring in the vessels and nerves of the head and neck.

Causes of development of pterygopalatine neuralgia (ganglionitis)

Pathology of ENT organs. Everyone knows such diseases of the sinuses of the skull as sinusitis and frontal sinusitis. There is also inflammation of the ethmoid labyrinth - ethmoiditis. Since the pterygopalatine ganglion is close to these structures, inflammation can also affect it;
Odontogenic mechanism of disease development: carious teeth, pulpitis, periodontitis are often the cause of the lesion;

Treat pulpitis on time - watch your teeth, otherwise ganglionitis may become a consequence.

Injuries of the maxillofacial area, consequences of fractures of the zygomatic bones;
Chronic intoxication: drinking alcohol, smoking, overwork, chronic lack of sleep, loud noise, all processes that can disrupt the balance of excitation - inhibition in the nervous system can also provoke the development of this disease;
This neuralgia can also be caused by tumors that form in the maxillary space, curvature of the nasal turbinates and septum, as a consequence of injuries. In addition, irritation of the ganglion can be caused by viral infections, herpes, local purulent diseases - follicular and lacunar tonsillitis, retropharyngeal and peripharyngeal abscess.

Follicular tonsillitis

How ganglionitis manifests itself, symptoms of ganglionitis

The classic sign, as with other neuralgia, is sharp, severe, short pain, similar to a lightning strike. They can be localized in various parts of the face: most often, pain occurs in the orbit, around the eye, at the base of the nasal bones. Sometimes shooting pains occur in the upper jaw (on one side), but sometimes sharp, strong attacks are possible in the teeth of the lower jaw or several teeth at once.

Many describe the pain as “bursting”, it is so strong.

In addition, due to the interaction of the ganglion with surrounding structures, sharp attacks of pain can occur in the ear, neck, back of the head, and temporal zone. In some cases, shooting pains can even reach the shoulder blade, the back of the head and, in some circumstances, even radiate to the hand.

Such localization of pain can be quite real with ganglonitis

A characteristic feature of pterygopalatine neuralgia are signs of autonomic dysfunction that accompany a painful attack. This “vegetative storm” can be manifested by the following symptoms:

Redness or paleness of one half of the face, which is especially noticeable to others;
Violation of tissue trophism, the appearance of swelling;
Excessive secretion due to the involvement of parasympathetic branches: increased lacrimation from one eye on the affected side, discharge of watery secretion from one nostril (also on the affected side);
Hypersalivation is increased salivation, and, as a rule, on one side of the oral cavity - on the affected side. During an attack, saliva can be released so much that it comes out “a mouth full.” If the patient uses a towel, it must be changed very often;
Sometimes patients are even bothered by asthma attacks;
Since the pterygopalatine ganglion contains fibers of the facial nerve, taste distortion is possible. As a rule, there is a feeling of bitterness, especially at the base of the tongue and its back.
Since a large number of autonomic fibers are involved, general reactions are possible: collapsed states, fainting, and possible hypertensive crises.

Separately, we can distinguish “ophthalmic” symptoms: if they prevail over pain, the patient may first see an ophthalmologist. These signs include:

Mild exophthalmos – protrusion of one eyeball on the affected side, which is associated with an increase in intraocular pressure;

The photo shows mild exophthalmos

Photophobia is a symptom that is associated with dilation of the pupil on the affected side (due to the fact that a lot of light enters the retina); miosis occurs much less often - that is, narrowing of the pupil;
Edema of the eyelid, lacrimation, blepharospasm, and conjunctival hyperemia may occur. In this case, an erroneous diagnosis of “conjunctivitis” is almost always made, and drops and antibiotics are prescribed. Of course, this does not lead to any noticeable result.

As a rule, an attack lasts no more than a few hours, but sometimes pain and vegetative paroxysms can last up to several days.

Like other attacks of cranial neuralgia, the onset of pain is typical at night, which can be the cause of persistent insomnia.

There is a principle of “emergency diagnosis”: if, during painful attacks, the posterior wall of the nasal cavity is irrigated with a solution of adrenaline along with an anesthetic, for example lidocaine. Previously, a solution of cocaine was used for this purpose.

The course of the disease is quite long; once it begins, attacks with varying frequency can bother a person for a number of months and even a number of years.

How to treat ganglionitis

Treatment during acute pain involves:

Lubrication or irrigation of the posterior sections of the nasal cavity, the area of the choanae with an anesthetic: novocaine, lidocaine;
To relieve severe vegetative symptoms, ganglion blockers are used: arfonade, pyrylene, pentamine, benzohexonium. They can be administered intramuscularly;

One of the ganglion blockers is pentamin.

In the event that the activity of the parasympathetic departments is pronounced, then drugs that reduce secretion, such as platyphylline, are used;
Also, if the doctor has the skills (for example, the patient is in the department of maxillofacial surgery, or ENT), then it is possible to block the pterygopalatine node;
Sometimes the use of desensitizing, antiallergic drugs, for example, antihistamines (betahistine, suprastin), has a good effect;
A good effect is also possible with the administration of tranquilizing drugs, such as Relanium, Sibazon.

Treatment of ganglionitis during the interictal period

After stopping the attack, you need to start looking for the reasons that led to the development of acute pain: you need to treat inflammation in the sinuses of the skull (treat sinusitis, sinusitis, ethmoiditis, visit a dentist, have your teeth sanitized). Antibiotics and drugs that enhance immunity are used.

During the interictal period, taking anticonvulsants (primarily carbamazepine), as well as antidepressants, except amitriptyline, has a good effect. Electrophoresis of anesthetics (Novocaine), application (UHF), and diadynamic currents have a good effect in preventing an attack.

Any neurologist, after treating ganglionitis, will refer the patient to UHF procedures.

Treatment of this disease should be carried out taking into account the improvement of the general background of the body: taking multivitamins, physical education, correction, taking medications that reduce the manifestations of atherosclerosis. An important factor that reduces the risk of developing this neuralgia is proper cerebral circulation.

Neurotropic group B drugs (thiamine, pyridoxine, cyanocobalamin) are used in treatment. A modern complex preparation that allows you to combine these vitamins is Milgamma Compositum.

In addition, the use of neuroprotectors (piracetam, Nootropil) and drugs that improve cerebral circulation is indicated.

In case of treatment-resistant, persistent and severe pain, radiofrequency destruction of this node can be used, which significantly reduces the frequency and intensity of pain impulses. Of course, it is not recommended to destroy such an important node, since you can get a lot of unforeseen phenomena, such as dry eyes, dry nasal mucosa and much more.

An alternative option is X-ray therapy, which uses a directed beam of radiation.

Almost always, an ENT doctor, and especially a dentist, can find your pathology and begin to treat it as effectively as possible and, unfortunately, in our time, as expensively as possible.

Therefore, patients come to a neurologist as a result of the powerlessness of other specialists, “football”, and, as a rule, with an empty wallet. If such unusual facial pain occurs, take the time to visit a competent neurologist and carefully tell him about your complaints.