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

Many are interested in what it is - ganglionitis. This is a disease based on inflammation of the ganglion. So called 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, such a condition is called polyganglionic.

After determining the symptoms, diagnosing and treating ganglionitis, they begin to use medications and undergo physiotherapy.

The reasons

The most common cause of ganglionitis is the penetration of infection, resulting in an inflammatory process. The source of infection are 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 node in purulent otitis media. Factors contributing to the occurrence of ganglionitis of the pterygopalatine ganglion are lack of sleep, overwork, stressful situations, alcohol intake, 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 pains and unpleasant itching. Often, patients develop paresthesia - numbness and tingling on the skin in the area of the inflamed ganglion. If the inflammation is diagnosed as herpetic, vesicles 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 its color as well as texture.

ulcers

Ganglionitis is easy to determine in the most difficult cases of the development of the disease, when ulcers appear on the affected area of the skin, and the internal organs lose their functionality due to damage to the nerve nodes. Muscles located in the area of inflammation also undergo degeneration. They weaken, lose their tone. The joints lose their mobility, due to which the speed of the patient's reflexes is reduced. Often, patients complain of heart problems and angina pectoris, but this is caused by inflammation in the region of the stellate node, 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 in viral infections to post-traumatic inflammation.

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

Considering the types of ganglionitis, one should dwell on the following diagnostic features:

With the localization of ganglionitis in the region of the sternum and upper shoulder girdle, the so-called stellate node is affected. The symptoms and treatment of stellate ganglionitis are very variable and often misleading in making a diagnosis. In this case, the patient may complain of heart pain, after a detailed examination, false angina pectoris can be diagnosed.
When the disease is localized in the region of the eyeball, inflammation affects the Gasser node, while symptoms of keratitis, photophobia, swelling in the eye area, and a rash are noted. This type of ganglionitis can be the result of a herpes infection.
upper respiratory tract, hearing aid and oral cavity (tonsillitis, sinusitis, pharyngitis, otitis media, pulpitis and caries) can provoke ganglionitis in the pterygopalatine node located in one of the maxillary sinuses. This localization is characterized by soreness in almost all parts of the face and head (painful touches to the ears, eye sockets, tip of the nose, temples, sometimes pain even descend to the area of the upper shoulder girdle).
Ramsey-Hunt syndrome can be attributed to a separate type of ganglionitis, when the focus is localized in the region of the auricle. It is the result of a herpetic infection. Symptoms of this type include ear pain, dizziness. It differs from the previous lesion of the pterygopalatine node by the manifestation of paresis of the facial nerve.
Symptoms and treatment of cervical ganglionitis are determined by the doctor. As a rule, the disease is a consequence of cervical osteochondrosis, in addition, any of the infections can be caused or develop against the background of the clinical picture of tonsillitis. Pain in this form is localized in the region of the shoulder girdle, the occipital part of the head. In addition, additional symptoms of ganglionitis of the cervical node may be redness of the face, eyes, asymmetric wrinkles on one side of the face, difficulty breathing due to nasal congestion.
Pain directly in the tongue, which at the same time passes into the jaw and further into the region of the temples, neck and occiput - these are symptoms of ganglionitis of the pterygopalatine ganglion. Treatment and additional diagnostics in this case is prescribed by a specialized specialist. In addition, salivation increases, the soft tissues of the tongue become hypersensitive, and it hurts the patient to move his jaws.
Ganglionitis of the ciliary ganglion (or Oppenheim's syndrome) develops against the background of a herpes infection or as a consequence of chronic untreated sinusitis. The characteristic symptomatology for this lesion is expressed in lacrimation, localization of the pain syndrome in the region of the orbits and temples.
There is also herpetic ganglionitis (symptoms and treatment will be determined by a specialist). It should be noted 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, anamnesis of the disease, clinical manifestations, and instrumental diagnostics.

Complaints of patients are varied and depend on the localization of inflammation. Most often, acute paroxysmal pain, swelling and itching of the affected area, fever, excessive sweating, weakness, loss of strength, limitation of movement in the joints are of concern.

A survey of the history of the disease 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, a thorough examination of the affected area is performed.

Palpation of the projection points of the node reveals soreness, impaired sensitivity. 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 a consultation with a neurologist, ENT doctor and dentist. As instrumental research methods, pharyngoscopy (examination of the pharynx) and otoscopy (examination of the ear) are used. It is possible to carry out x-ray diagnostics.

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, less often surgical is widely used.

medicinal substances

As already mentioned, the symptoms and treatment of ganglionitis (photos of people suffering from this unpleasant ailment are presented in the article) depend on the type of disease. Therapy is purely individual. But it will all come down to physiotherapy and medication. The operation requires certain actions, this issue is decided by each doctor, based on the individual characteristics of each.

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

Reception "Interferon". The body needs antibacterial and antiviral support.
Treatment with drugs with desensitizing properties. These include Diazolin, Tavegil, Ketotifen.
Also, the course of treatment involves taking analgesics ("Analgin", "Indomethacin", "Diclofenac").
You will need ganglionic blockers. For example, Gangleron or Pentalgin.
It will not be superfluous to use vasodilators (Nikospan, Thionikol, Papaverine).
At some stages, antihypoxants will be required: "Aevit", "Sodium oxybuterate".
For better metabolism in tissues and activation of reparative-regenerative processes, "Pentoxyl", "Petiluracil" are suitable. The use of immunomodulators is vital.

Physiotherapy

Any physiotherapy will be aimed at solving a whole range of problems. With ganglionitis, you must first stop the pain syndrome. The methods used are anesthetics. It is necessary to solve the problem of intoxication and inflammation. Antimicrobial and antiviral therapy will help here. In inflammatory processes, the anti-exudative method of physiotherapy will help. Allergic reactions that occur will be removed in any way possible. In order to normalize all the functions of the peripheral nervous system, they will resort to a method when all free nerve endings are irritated. From dystrophy, a trophostimulating method is used. Immunostimulating physiotherapy will be chosen to correct immune dysfunction.

Spa treatment

Sometimes patients are sent simply to rest in a sanatorium. This is done at the time of 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. Resorts are suitable for absolutely any. It doesn't matter if it's mud baths or a rocky beach. The only important thing is the process in which a person will give rest to the nervous system of the body, put himself in order. It should be noted that this happens best by the sea because of the salty air.

Prevention

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

You should lead a correct lifestyle and give up bad habits, do not eat a lot of fatty and salty foods.
You need to exercise every day. Morning runs will not be superfluous.
Hardening strengthens the immune system well, but you should not immediately douse yourself with ice water. You need to start gradually with light douches in the bath, with rubbing the limbs with a cold and wet towel, and then you can smoothly move on to dousing in the fresh air, but at first only in the warm season.
Do not forget about the hat in the cold season. After all, no hairstyle can be more expensive 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 the immune system with vitamins, eat more fruits and vegetables.

It is also important to get vaccinated in advance, it will provide the body with strong immunity against this disease. During an outbreak, a special protective mask must be worn.

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

pterygopalatine;
ciliary;
ear;
cranked;
trigeminal;
submandibular;
sublingual;
stellate;
upper cervical.

The cause of the disease can be a variety of acute, chronic infections. For example, malaria, brucellosis, syphilis, tonsillitis, influenza, rheumatism, herpes. In addition, trauma, tumors, intoxication, corticosteroid therapy can be factors for the onset 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's 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 varied. This is due to the fact that the node has individual anatomical features for each person and a large number of anastomoses. The pain is burning, bursting, very intense in half of the body (hemitype). Pain can be localized not only in the area where the knot itself is located, but also in such areas: around the orbit, in the eye, the root of the nose, the upper and lower jaws (teeth, gums), temples, auricle, back of the head, shoulder, forearm, hand.

Pain is accompanied by catarrhal syndrome: flushing and swelling of the face, lacrimation, rhinorrhea with one nostril, salivation. This condition is more often observed at night, the duration of the paroxysm is from several minutes to several days.

To confirm the ganglionitis of the pterygopalatine node, the method of lubricating the nasal cavity with a solution of dicaine with adrenaline is used, after which the pain disappears.

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

Inflammation of the cervical sympathetic nodes

Etiological factors are predominantly 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 internal apple, Bern-ra-Horner syndrome and Pourfure-de-Petit.

Causes: tonsillitis, chronic infectious diseases, intoxication.

Most often, patients complain of pain in the cervical-occipital region and shoulder girdle. On palpation of pain points in the projection of the node, the exit 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 node

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, neck, temples. Pain increases 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 be a necessarily lingual-submandibular pain phenomenon.

Ganglionitis of the geniculate ganglion (Ramsey 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, 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 have a neuropathic character. 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, tinnitus. On examination, there will be horizontal nystagmus and paresis of facial muscles. Sensitivity is impaired on half of the tongue.

Ganglionitis of Gasser (trigeminal) node

The disease is caused by a herpetic infection that occurs against a background of reduced immunity, especially in the elderly.

Ganglionitis is characterized by fever, general malaise, intoxication, photophobia, paresthesia, excruciating and persistent 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 zone are observed.

Ciliary lesion (Openheim's syndrome)

The main causes are sinusitis, the herpes virus.

Characteristic. The pain is paroxysmal in the forehead, eye socket, temples, root of the nose and hard palate. It causes such a feeling that the eyeballs seem to protrude from the orbit. On examination, the mucous membrane of the eye is red, the eyelids are swollen, profuse lacrimation, Petit's syndrome, Horner's syndrome.

Ganglionitis of the ear node (Frey's syndrome)

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

Paroxysmal pain with signs of vegetalgia occurs in the area in front of the temporomandibular joint, temples, and ear. Irradiates (gives off) to the back of the head, neck, shoulder girdle, arm, upper chest. The patient in this case 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 node

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

Diagnostics

It is sometimes very difficult for doctors to make an accurate diagnosis. It is necessary to consult a neurologist, dentist, ENT.

The diagnosis is based on clinical data:

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

On examination, there will be pain on palpation of the pain points of the projection of the node itself and its nerves, a violation of sensitivity.

Sometimes additional diagnostic methods are used: otoscopy, pharyngoscopy, radiography.

How is ganglionitis diagnosed?

Differential diagnosis is carried out with such diseases as syringomyelia, meningoradiculitis, neurovascular syndrome, neuritis of 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 such methods of therapy that are suitable in a particular case and depending on the general condition of the patient.

Of the methods of physiotherapy, they use: ultrasound therapy, ionogalvanization, phonophoresis, Bernard currents, UV irradiation, electrophoresis, laser therapy.

In addition, low-temperature therapeutic muds, baths (radon, salt, hydrogen sulfide), ozocerite applications are used.

Drug therapy includes the appointment of such drugs:

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

If medical and physiotherapeutic methods are ineffective or contraindicated, then surgical intervention is recommended. To do this, carry out novocaine blockade of the node or destroy it with the help of alcoholization. In addition, the operation is indicated in the case when the ganglion is affected by a tumor.

Forecast

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

Prevention

First of all, it is necessary to treat chronic diseases, as 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, refrain from stressful situations. You can use immunostimulants. In addition, it is necessary to avoid hypothermia, injury.

For the treatment of ganglionitis, it is necessary to first understand and find out the etiological factor. There are many options for therapy, it all depends on the affected ganglion, the patient's condition, concomitant diseases, contraindications. The prognosis for well-chosen treatment is quite favorable.

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

The reasons

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 the disease are distinguished: cervical, thoracic, lumbar, sacral ganglioneuritis. In addition, the diagnosis may contain the name of the affected node (for example, pterygopalatine ganglioneuritis, ganglioneuritis of the pelvic plexuses) or indicate the etiology of the disease (staphylococcal, herpetic, postherpetic ganglioneuritis).

Inflammation of the ganglion can lead to:

chronic pathologies - complicated caries (pterygopalatine ganglioneuritis), 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 the defeat of the nerve nodes:

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 sensation of pulsation (bursting). Localization of discomfort depends on the location of the node. In some cases, they extend to the entire half of the body or the opposite side. The pain does not increase with movement, but may become more intense with changes in the weather, stress, and eating.

In addition, inflammation of the ganglion is supplemented by:

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

The 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 intercourse;
aching pains in the lower abdomen, radiating to the perineum and rectum;
violation of the menstrual cycle, uterine bleeding.

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

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

expansion of the palpebral fissure;
hyperthyroidism by stimulating the thyroid gland;
redness of half of the face;
change in sensitivity above the second rib;
paresis of the larynx, hoarseness of voice;
toothache (in some cases).

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

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

Other possible manifestations of inflammation of the ganglia:

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

Diagnostics

Inflammation of the nerve node 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:

X-ray of the spine;
electromyography;
Ultrasound of the abdominal cavity and pelvis;
Ultrasound of the prostate and others.

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

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

The defeat of the ganglion is differentiated from funicular myelosis, spinal tumor, neurosis, and so on.

Treatment

The treatment algorithm for ganglion vevritis 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 zones:

analgesics, including intravenous administration of novocaine and blockade in the affected area;
ganglioblockers, anticholinergics, antipsychotics, 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 - UVI, electrophoresis (with ganglerone, potassium iodide, novocaine), radon baths, mud applications.

With the ineffectiveness of conservative therapy, sympathectomy is performed - the removal of the affected area of the autonomic nervous system. Depending on the localization 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 laparo- or thoracoscopy.

Forecast

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

Prevention

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

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Ganglionitis (ganglioneuritis) of the pterygopalatine node one of the neurostomatological syndromes. This symptom complex is characterized by a significant variability of clinical manifestations. The node has three main roots: somatic (sensitive) - from the II 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, ear, upper cervical sympathetic nodes and cranial nerves, especially with the trigeminal and facial.

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

Clinical picture . Neuralgia of the pterygopalatine ganglion (Slader's syndrome) is characterized by spontaneous sharp pains in the eye, around the orbit, in the region of the root of the nose, upper jaw, and sometimes in the teeth and gums of the lower jaw. Pain can spread to the area of the temple, auricle, occiput, neck, shoulder blade, shoulder, forearm and even the hand. Painful paroxysms are accompanied by pronounced vegetative symptoms, a kind of "vegetative storm" (reddening of half of the face, swelling of facial tissues, lacrimation, profuse secretion 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 node is the cessation of the attack after lubrication of the posterior parts of the nasal cavity with a solution of cocaine with adrenaline.

The disease continues for months and even years. After an attack, a number of vegetative symptoms remain in a mild degree. The variety of clinical manifestations of the lesion of the pterygopalatine node 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% solution of novocaine are injected into the nasal cavity. With sharp pains, ganglionic blockers (benzogexonium, pentamine) are prescribed. In severe cases, they resort to blockade of the node with the help of anesthetics. Treatment must be comprehensive. If the syndrome develops against the background of inflammatory processes in the paranasal sinuses, face, oral cavity 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 injections of hydrocortisone into the projection area of the node. Assign pahikarpin, antispasmodics, antipsychotics in combination with antidepressants. If the symptoms of irritation of the parasympathetic part predominate in the clinical picture, then anticholinergics (platifillin, spasmolitin, belladonna preparations, metacin, aprofen) are used.

Endonasal electrophoresis of 2% solution of novocaine, UHF-therapy, diadynamic currents are used. After the subsidence of acute phenomena, mud applications of low temperatures (36-37 ° C) are used on the affected side or in the form of a collar. Spend a light massage of the muscles of the neck and face. Group B vitamins, biogenic stimulants (aloe extract, FIBS, vitreous body) are shown. 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 with a 2% solution of trimecaine or alcoholization. Node destruction is rarely used. The treatment carried out does not always relieve patients from relapses of the disease, however, the severity of clinical manifestations is significantly reduced.

Pterygopalatine neuralgia, as we already wrote, is also called ganglionite pterygopalatine node, which indicates the inflammatory component of neuralgia - since all inflammatory diagnoses end in "-it". Ganglionitis refers to a disease that is treated first by dentists and then by neurologists, and the manifestations of the disease are combined into one "neurodental" syndrome.

Cranial nerves - pterygopalatine ganglion

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

ganglion structure

The pterygopalatine node lies "at the junction" of many "roads" of the peripheral nervous system. This is the reason for 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 systems of the facial and trigeminal nerves, the pterygopalatine ganglion is connected to a large extent with the sympathetic ganglia and other ganglia, for example, the ear and ciliary.

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

Reasons for the 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 closely adjacent to these structures, inflammation can also affect it;
Odontogenic mechanism of the development of the disease: carious teeth, pulpitis, periodontitis - often cause lesions;

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

Injuries of the maxillofacial region, the consequences of fractures of the zygomatic bones;
Chronic intoxication: alcohol consumption, smoking, overwork, chronic lack of sleep, loud noise, all processes that can upset the balance of excitation - inhibition in the nervous system can also provoke the development of this disease;
Tumors that form in the retromaxillary space, curvature of the turbinates and septum, as a consequence of injuries, can also lead to this neuralgia. In addition, irritation of the ganglion can cause viral infections, herpes, local purulent diseases - follicular and lacunar tonsillitis, retropharyngeal and peripharyngeal abscess.

Follicular angina

How ganglionitis manifests itself, symptoms of ganglionitis

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

Many describe the pain as "bursting" because it is so strong.

In addition, due to the interaction of the ganglion with surrounding structures, sharp attacks of pain can be in the ear, neck, nape, and temporal zone. In some cases, shooting pains can even reach the shoulder blades, the back of the head, and under some circumstances, even give into 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 pain attack. This "vegetative storm" can manifest itself in the following signs:

Redness or blanching of one half of the face, which is especially noticeable to others;
Violation of tissue trophism, the appearance of puffiness;
Excessive secretion due to the involvement of parasympathetic branches: increased lacrimation from one eye on the side of the lesion, separated watery secret from one nostril (also on the side of the lesion);
Hypersalivation - increased salivation, and, as a rule, on one side of the oral cavity - on the side of the lesion. Saliva during an attack can stand out so much that it departs "with a full mouth." If the patient uses a towel, then it has to be changed very often;
Sometimes patients are disturbed even by asthma attacks, reminiscent of asthma;
Since there are fibers of the facial nerve in the pterygopalatine ganglion, a perversion of taste 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 vegetative fibers are involved, general reactions are possible: collaptoid states, fainting, hypertensive crises are possible.

Separately, “ophthalmic” symptoms can be distinguished: if they prevail over pain, the patient may first be seen by an ophthalmologist. Such signs include:

Light exophthalmos - protrusion of one eyeball on the side of the lesion, which is associated with an increase in intraocular pressure;

In the photo, mild exophthalmos

Photophobia is a symptom that is associated with pupil dilation on the side of the lesion (due to the fact that a lot of light enters the retina), miosis is much less common - that is, pupil constriction;
Perhaps the appearance of eyelid edema, lacrimation, blepharospasm, and conjunctival hyperemia. In this case, an erroneous diagnosis of "conjunctivitis" is almost always made, 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 autonomic paroxysms can last up to several days.

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

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

The course of the disease is quite long, having begun once, attacks with different intervals can disturb a person for a number of months and even a number of years.

How to treat ganglionitis

Treatment during the period of acute pain involves:

Lubrication or irrigation of the posterior parts of the nasal cavity, the choanal region with an anesthetic: novocaine, lidocaine;
To stop severe vegetative symptoms, ganglionic blockers are used: arfonad, pyrilene, pentamine, benzohexonium. They can be administered intramuscularly;

One of the ganglionic blockers is pentamine.

In the event that the activity of the parasympathetic divisions is expressed, then drugs that reduce secretion are used, such as platifillin;
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 introduction of tranquilizing drugs, such as relanium, sibazon.

Treatment of ganglionitis in the interictal period

After stopping the attack, you need to start looking for the causes that led to the development of acute pain: you need to treat inflammation in the sinuses of the skull (treat frontal sinusitis, sinusitis, ethmoiditis, visit a dentist, sanitize teeth). Antibiotics, drugs that increase immunity are used.

In the interictal period, anticonvulsant drugs (primarily carbamazepine) and antidepressants, except for amitriptyline, have a good effect. A good effect, preventing an attack, has electrophoresis of anesthetics (novocaine), application (UHF), diadynamic currents.

Any neurologist after treatment of 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 drugs that reduce the manifestations of atherosclerosis. An important factor that reduces the risk of developing this neuralgia is a full-fledged cerebral circulation.

Of the drugs in the treatment, neurotropic groups B (thiamine, pyridoxine, cyanocobalamin) are taken. A modern complex preparation that allows you to combine these vitamins is Milgamma Compositum.

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

In the 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, dryness of the nasal mucosa, and much more.

An alternative option is x-ray therapy, which can be done using a directed beam of radiation.

Almost always, an ENT doctor, and especially a dentist, can find their own pathology and undertake to treat it as efficiently as possible and, unfortunately, in our time - as expensive as possible.

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