Ganglioneuritis is an inflammation of the ganglion (ganglion), which is accompanied by damage to the sympathetic, parasympathetic or sensitive 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 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 (ganglioneuritis of the pterygopalatine node), adnexitis, salpingitis, oophoritis, prostatitis (sacral, pelvic ganglioneuritis);
- acute diseases - diphtheria, influenza, erysipelas, angina, 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 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 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 due to stimulation 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 organs abdominal cavity.
Other possible manifestations ganglion inflammation:
- 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 node 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- zovirax, acyclovir. If the pathology is caused bacterial infection antibiotics are used.
General directions for the treatment of ganglioneuritis of the lower sternum and other zones:
- analgesics, including intravenous administration 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 inefficiency conservative therapy sympathectomy is performed - 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 long time, the patient's ability to work is reduced.
Prevention
The main measures to prevent inflammation of the nerve nodes - timely treatment infectious diseases and strengthening the immune system.
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Ganglionitis - inflammation of the ganglion, the constituent components of which are the bodies 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 which 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 for each person anatomical features 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 node itself is located, but also in such areas: around the orbit, in the eye, the root of the nose, upper and mandible(teeth, gums), temples, auricle, nape, 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
The 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 pain points in the projection of the node, the exit site of the occipital nerves, the paravertebral region, pain is felt. Accompanied by redness and atrophy of the corresponding half of the face.
Upper ganglionitis 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. Anterior part of tongue and mucosa oral cavity 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, they are observed in the affected areas and on the mucous ( soft palate, tonsils) herpetic rashes. 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 part 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 increase temperature;
- malaise.
On examination, there will be pain on palpation of 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 carried out with diseases such as syringomyelia, meningoradiculitis, neurovascular syndrome, somatic nerve neuritis, diseases of the heart and abdominal organs.
Treatment of ganglionitis
Therapy depends on the cause that led to pathological condition. Doctors prescribe such methods of therapy that are suitable in a particular case and depending on general condition sick.
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 syndrome;
- antibiotics, sulfa drugs (in the process caused by bacteria);
- antiviral - if available herpetic 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);
- nootropics to improve cerebral circulation(mainly for the elderly);
- B vitamins (cyanocobolamine, B6);
- anticholinergic drugs (platifillin, metacin) - if severe symptoms 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 it is recommended surgical intervention. 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 physical culture 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 condition of the patient, concomitant diseases, contraindications. The prognosis for well-chosen treatment is quite favorable.
Ganglionitis is a disease resulting from an infection (influenza, rheumatism, malaria, tonsillitis, herpes zoster, etc.) of one sympathetic nerve node or several nodes at once that have segmental roots and peripheral nerves. Also, ganglionitis can happen due to tumors, injuries and toxins.
Types and symptoms
In most cases, it is characterized by burning paroxysmal pains with itching in the area of the affected ganglion and paresthesias (numbness, tingling). We list the most common types.
Herpetic. It is accompanied by the formation of rashes in the form of bubbles on the skin along the corresponding nerve trunk, which are painful. You will also feel pain in the area of the spinous processes of the vertebrae, if you feel them with your fingers. Functioning is disturbed internal organs due to the fact that the nodes that ensure their work are affected. In the area of the affected ganglion, the skin color changes, in rare cases, skin ulceration occurs, the functions of thermoregulation and regional sweating are affected, and subcutaneous tissue swells. Regional muscles gradually weaken and lose their tone, they atrophy, contractures occur. Reflexes become worse, joint mobility decreases. In the case of disease of the upper cervical sympathetic ganglion, such pathologies occur in the head, neck and face.
Star node. There are pains in upper section chest and arm, as well as false angina syndrome.
Gasser node. This disease is manifested as a result of age-related suppression of immunity. This disease is much more difficult to pass, unlike herpes that has arisen in other places. Pain and rashes in most cases appear in the zone of innervation of the first branch of the trigeminal nerve, and also occur in the second and third branches. There is a risk of keratitis (inflammation of the cornea), accompanied by rashes in the form of small dots, fear of light and darkening of the surface layers.
Pterygopalatine node. Occurs with inflammation of the main and maxillary sinuses, the ethmoid labyrinth, because it is very close to the lower and upper jaw. The disease is characterized by acute pains in the eyes and around the orbit, in the area of the upper jaw and root of the nose, less often in the teeth and gums of the lower jaw. The pain can spread further, starting from the temple area and ending even with the hands.
Crank node. Known as Ramsey-Hunt neuralgia, it is accompanied by herpetic eruptions of the ear, pain in the ear canal, and weakening of the face on the affected side. It also sometimes causes dizziness. Lesions of the lumbar and lower thoracic nodes are accompanied by a violation of the functions of organs in the abdominal cavity and small pelvis.
Diagnostics
The diagnosis of this disease is made only on the basis of clinical data. Differential diagnosis is carried out with neuritis of somatic nerves, syringomyelia, meningoradiculitis, and neurovascular syndromes. In the case of lower thoracic and lumbar ganglionitis, diseases are excluded abdominal organs, and with upper thoracic and cervical ganglionitis - heart disease.
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Treatment
The treatment of ganglionitis depends on its etiology. Usually in case inflammatory processes doctors prescribe desensitizing agents, antiviral and immunomodulatory agents to the patient.
Complex therapy consists of drugs that can reduce the excitability of vegetative formations. These include B vitamins, ganglion blockers (the most effective are gangleron and pahikarpin). Treatment for neuropathic pain is special preparations- anticonvulsants and antidepressants. Treatment with drugs is usually long-term, if necessary, it is supplemented with metabolic and vascular agents.
Novocaine blockade of the affected node is also carried out. Sometimes effective for ganglionitis and physiotherapy, which includes ultrasound therapy, Bernard currents, salt, radon and hydrogen sulfide baths, therapeutic mud, etc.
Ganglioneuritis is a severe neurological disease in which inflammatory processes affect the ganglion and its associated nerve trunks (peripheral nerves and nerve sensitive nodes). Second name this disease- ganglionitis. Inflammation can spread not to one sympathetic node, but to several at once (polyganglionic or truncite). Sometimes inflammation of the sympathetic nodes occurs in combination with an inflammatory process in the spinal nerve fibers. In this case, ganglioneuritis is differentiated as ganglioradiculitis.
IN individual cases the inflammatory process affects the nerve nodes, which include nerve fibers various kinds- parasympathetic, sympathetic, sensitive. The most common of these are ganglioneuritis of the geniculate node and ganglionitis of the pterygopalatine node. And in the process of disease progression, different ganglia can be affected.
Based on this, the disease is divided into several types:
- sacral;
- cervical (lower cervical, upper cervical, stellate);
- chest;
- lumbar.
Causes of ganglioneuritis
The very first cause of this disease is an infectious process. The causative agents can be:
- acute infections: measles, dysentery, sepsis, diphtheria, tonsillitis or influenza;
- chronic infectious diseases (syphilis, tuberculosis, rheumatism).
Complicated dental caries can serve as the cause of ganglioneuritis of the pterygopalatine node, and adnexitis or prostatitis (in men) can provoke sacral ganglionitis. In rare cases, ganglioneuritis can be triggered by a tumor (ganglioneuroma or secondary metastatic process), then the disease is toxic in nature.
Risk factors in the occurrence of ganglioneuritis will be nervous overexertion, hypothermia, constant overwork, alcohol dependence, operations that were performed in the ganglia.
Common symptoms of ganglioneuritis
Symptoms of ganglioneuritis depend on the level of the lesion, it has a complex clinical picture. Pain will be the main symptom in the clinical picture. The pain is characterized by a strong burning sensation and arching character, patients also note a feeling of pulsation.
Patients often cannot pinpoint the source of pain because the disease is diffuse. Patients describe pain in the entire half of the body, focusing on the fact that pain is permanent and does not change with movement. Increased pain occurs with a change in weather, transferring stressful situations, after eating.
In addition to the pain syndrome with ganglioneuritis, there is also a loss or partial impairment of sensitivity in the form of hyperesthesia (increased sensitivity) or vice versa hypesthesia (decreased sensitivity). Sometimes there is also paresthesia (a feeling of numbness, a feeling of "goosebumps", tingling or lethargy).
There are cases of neurotrophic and vasomotor disorders, which are expressed in the area of localization of the affected ganglion and associated nerve fibers. If the disease is of a long-term nature, there may be sleep disturbance, emotional instability, the development of neurasthenia, asthenia, and hypochondriacal syndrome.
Symptoms of certain types of ganglioneuritis
The localization of the inflammatory process determines the degree of complexity of the disease. The classification of ganglioneuritis depends on the group of affected sympathetic ganglia.
Ganglioneuritis of the upper cervical node
The clinical picture in ganglioneuritis of the upper cervical ganglion is characterized, first of all, by the symptoms of the Bernard-Horner syndrome. The inflammatory process in this ganglion provokes the development of the Pourfure du Petit syndrome (enlarged palpebral fissure, exophthalmos). The inflammatory process affects the functionality of the thyroid gland and excites the appearance of hyperthyroidism. There are secretory and vasomotor disorders (hyperhidrosis, redness in half of the face, lowering intraocular pressure). Sensitivity disturbances are observed in the area of the second rib. Perhaps a change in voice or paresis of the larynx. Sometimes patients feel a strong pain syndrome extending to the jaw area. Due to the inability to identify the exact source of pain, people often mistakenly resort to dental treatment, which for obvious reasons does not give any results.
Ganglioneuritis of the lower cervical node
With this type of ganglioneuritis, a more extensive sensitivity disorder is observed (it extends to the sixth rib and to the arm). When the hand is affected, there is a decrease in muscle tone, a change in skin color on the surface of the entire hand or on the fingertips. There is also a violation of reflexes - correlative, conjunctival, maxillary, pharyngeal, carporadial. Sometimes there is a drop auricle from the affected node.
Ganglioneuritis of the stellate ganglion
The clinical picture is characterized by the presence of pain in half of the chest on the side of the inflamed node. Violations of sensitivity and motor reflexes are observed in the fingers. Especially noticeable is the violation of motor skills in the fifth finger of the hand located in the affected area. Region pain, loss or disturbance of sensitivity has a so-called "half-jacket" appearance. Often, the pain extends to the chest area, therefore it resembles angina attacks and must be differentiated from coronary heart disease.
Ganglioneuritis of the upper thoracic sympathetic nodes
This type of ganglioneuritis manifests itself in the form of pain and sensitivity disorders, as in previous cases. But a characteristic difference will be disorders of the vegetative-visceral system. There is shortness of breath, symptoms similar to the clinical picture in coronary heart disease.
sacral ganglioneuritis
A pain syndrome is characteristic. Symptoms may be accompanied by itching of the genital organs, often diagnosed as gynecological disease. Women sometimes experience menstrual irregularities or uterine bleeding.
Ganglioneuritis of the pterygopalatine node
The inflammatory process occurs in the pterygopalatine node, therefore, neuralgic symptoms of inflammation of the second branch of the trigeminal nerve (near the bridge of the nose and upper jaw) are observed. In the clinical picture, there is hyperemia of the affected part of the face, secretion from the nose (in the affected half) and lacrimation from the eye.
Ganglioneuritis of the geniculate node
There is pain in the ear, seizures and pain spreading to the occipital region, cervicofacial zone. On the affected part of the body, paresis or neuritis of the facial nerve with facial expression disorders can be observed.
Diagnosis of ganglioneuritis
Diagnosis of ganglioneuritis is a complex process, since the symptoms clinical picture similar to a number of other diseases (otitis media, ischemic disease heart, oncological formations, spinal formations, circulatory disorders, different types neurosis, etc.). The difficulty also lies in determining the variation of ganglioneuritis, since the symptoms of its various types are very similar. Untimely or misdiagnosis can significantly worsen the patient's condition, slow down the treatment process and, accordingly, lead to disappointing prognosis.
If at least some of the above symptoms appear, you should seek the advice of a neurologist. The initial diagnosis of ganglioneuritis usually occurs on the basis of an analysis of the clinical picture from the words of the patient and examination of the patient, identifying signs of vasomotor and neurotrophic disorders, and sensitivity disorders.
Hardware diagnostics of ganglioneuritis
Thoracic and sacral ganglioneuritis is especially difficult to differentiate and for the accuracy of the diagnosis, the patient undergoes a long examination for the presence of somatic diseases. For this, consultations of a gynecologist, cardiologist, gastroenterologist, and phthisiatrician are prescribed. In order to exclude a number of diseases, X-ray of the spine, electromyography, MRI and CT can be prescribed.
The inflammatory process often causes changes in the somatic organs, so the patient undergoes MSCT or ultrasound of the abdominal organs, genitals, prostate in order to identify these pathologies.
Treatment of ganglioneuritis
In the treatment of ganglionitis, anti-allergic drugs are prescribed, a course of antibiotic treatment is attributed (if the etiology of ganglioneuritis is of a bacterial nature).
Analgesics are indicated to relieve pain. In some cases, with a strong pain syndrome and the ineffectiveness of analgesics, novocaine is administered intravenously or paravertebral blockades with novocaine are performed in the affected area or sympathectomy is performed ( surgical removal the affected ganglion, which is used in case of ineffectiveness of any of the methods of pain relief).
Depending on the nature of the disease, anti-infective therapy may be prescribed. At viral etiology diseases are prescribed antiviral drugs and gamma globulin. With the defeat of the sympathetic system, cholinomimetic drugs, gluconate and calcium chloride can be prescribed.
For the treatment of this disease, physiotherapy is widely used, which sets itself the task of stopping the pain syndrome and the inflammatory process, and correcting disorders of the autonomic system. Removal of the pain syndrome occurs with the help of transcranial electroanalgesia, drug electrophoresis of anesthetics. The relief of intoxication is carried out by low-intensity UHF therapy. Antiviral methods consist in the patient undergoing UV radiation, etc. For recovery peripheral functions the body is credited with darsonvalization procedures, mustard and turpentine baths. Emerging allergic reactions are eliminated with the help of anti-allergic procedures - local aerosol therapy using antihistamines, nitrogen baths.
With proper diagnosis and adequate treatment, the prognosis is favorable for life.
Prevention of ganglioneuritis is timely treatment all kinds of inflammatory processes in the body, viral and infectious diseases. Sports are very important. Proper nutrition, long walks on fresh air, quitting smoking and alcohol are the best guarantors of health.
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 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 - 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: drinking alcohol, smoking, overwork, chronic sleep deprivation, , loud noise, all processes that can disrupt 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 angina, pharyngeal 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. characteristic feature pterygopalatine neuralgia are signs autonomic dysfunction that accompany pain. 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 neuralgia cranial nerves, characterized by the onset of pain at night, which can be the cause of persistent insomnia.
There is a principle of "urgent diagnosis": if during pain attacks, irrigation is carried out rear wall nasal cavity 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 acute pain suggests:
- 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, the reception has a good effect anticonvulsants(primarily carbamazepine), as well as antidepressants, except for amitriptyline. good effect, which prevents 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.
From medicines in the treatment they take neurotropic groups B (thiamine, pyridoxine, cyanocobalamin). modern complex drug, which 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.
The alternative is x-ray therapy, which can by 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 pains appear, take the time to visit a competent neurologist and carefully tell him about your complaints.
