Ganglionitis of the wing node is an inflammatory lesion of the cranial nerve node of mainly infectious etiology. Disease of the wing node is manifested by painful attacks in the affected half of the face, which are accompanied by vegetative symptoms (lacrimation, redness of the skin, swelling, salivation). Diagnosis of the disease is based on its clinical picture and the exclusion of other causes of facial pain. Pathology is treated with the complex use of painkillers, anti-inflammatory, antibacterial, ganglioblocking and antiallergic agents; lubrication of the nasal cavity with a solution of dicaine; physiotherapeutic agents (UHF, electrophoresis, mud treatment).
G50-G59 Damage to individual nerves, nerve roots and plexuses
The pterygoid node is located in the pterygoid-palatine fossa located in the suspensory region. It is formed by 3 roots: sensitive — formed by branches from the maxillary nerve (II branch of the trigeminal nerve), sympathetic — represented by a branch of the internal carotid plexus and parasympathetic — a large rocky nerve, which is a branch of the facial nerve. Branches emanating from the wing node innervate the eye socket, lacrimal gland and sphenoid sinus (orbital branches); nasal mucosa and latticed sinus (nasal branches); soft and hard palate, maxillary sinus (palatine branches).
In neurology, ganglionitis of the wing node is also called Slader syndrome after the author who described it in 1908. Ganglionitis of the wing node is a fairly common type of lesion of the vegetative ganglia. When not only the wing node is involved in the inflammatory process, but also the nerve roots that make up it, the disease is regarded as ganglioneuritis.
Ganglionitis of the wing node most often develops as a result of the penetration of infectious agents into the node, causing the development of an inflammatory process in it. The source of infection is often local inflammatory diseases of the nasopharynx: sinusitis, chronic rhinitis, pharyngitis; less often — arthritis of the temporomandibular joint. Ganglionitis of the wing node can occur as a result of toxic effects on the nerve node in chronic tonsillitis, chronic purulent otitis. Factors contributing to the occurrence of ganglionitis of the wing node are lack of sleep, fatigue, stressful situations, alcohol intake, loud noise.
In some cases, ganglionitis of the wing node acts as a neurostomatological complication in dental caries, accompanied by the development of pulpitis and periodontitis. Ganglionitis of the wing node can be observed against the background of common infectious diseases: ARVI, herpes infection, tuberculosis, rheumatism. The occurrence of ganglionitis of the pterygoid node is possible as a result of trauma with damage to the structures of the pterygoid-palatine fossa.
The basis of the clinical picture of ganglionitis of the wing node is a spontaneously occurring attack of intense facial pain. Ganglionitis of the wing node is never manifested by a pain syndrome limited to the area of the node location. Multiple anastomoses of the wing node of its roots and branches cause a variety of localization of pain and its widespread nature.
The dominant pain is in areas that are innervated directly by branches from the wing node: in the eyeball, upper jaw, at the base of the nose, in the hard palate. Sometimes the pain spreads to the area of the gums and / or teeth of the lower jaw. Often, ganglionitis of the wing node is accompanied by irradiation of pain in the occipital region, neck, auricle, temple, less often — in the shoulder, forearm, and sometimes even in the hand. Anastomoses of the wing node with nodes of the sympathetic trunk in some cases lead to the spread of pain syndrome to the entire half of the trunk.
An attack of ganglionitis of the pterygoid node is accompanied by pronounced vegetative disorders, which are manifested by swelling and redness of the affected half of the face, lacrimation, secretion of a large amount of saliva and copious secretion of liquid secretions from the corresponding half of the nose. For pronounced vegetative symptoms, ganglionitis of the wing node was called “vegetative storm”.
An attack can have a different duration from minutes to several hours or even days. Most often, such attacks occur at night. In the post-onset period, weakly expressed vegetative symptoms may persist with ganglionitis of the wing node. Ganglionitis of the wing node has a chronic paroxysmal course and can last for years. Exacerbations in spring and autumn are typical for him. They can be triggered by a transferred acute respiratory viral infection, hypothermia, a stressful situation, decreased immunity or weather changes.
To establish the diagnosis of “Ganglionitis of the wing node” allows a vivid clinical picture of the disease. To confirm the diagnosis, the posterior areas of the nasal cavity are lubricated with a 0.1% solution of dicaine and adrenaline. If this procedure allows you to stop a painful attack, then the ganglionitis of the wing node is confirmed.
It is necessary to differentiate the ganglionitis of the wing node from other diseases accompanied by facial pain (prosopalgia): trigeminal neuralgia, inflammatory diseases of the ear (otitis externa, acute otitis media, mastoiditis), dental pathology (acute toothache, pulpitis, periodontitis). In the process of diagnosis, it is necessary to identify or exclude the presence of an inflammatory focus, which can serve as a source of infection of the wing node and support the inflammatory process in it. For this purpose, consultations of a neurologist, dentist, otolaryngologist, otoscopy and pharyngoscopy, radiography of the paranasal sinuses and dental radiography can be carried out.
In the complex treatment, measures to relieve pain syndrome come out on top. They include the introduction of turundum with novocaine into the nasal cavity and the lubrication of the nasal cavity with dicaine. Pronounced pain is an indication for the appointment of ganglioblockers (azamethonium bromide, benzohexonium), in particularly severe cases, the wing node is blocked with anesthetics (lidocaine, novocaine, etc.).
Treatment of infectious and inflammatory etiology is combined with the use of anti-infectious (antibiotics) and anti-inflammatory drugs. An effective way to treat ganglionitis of the wing node is the introduction of a hydrocortisone solution into the area of the wing node. Antiallergic drugs (chloropyramine, loratadine, desloratadine) are prescribed without fail. The use of general tonic agents, vitamins of group B is shown.
According to indications, antispasmodic drugs, neuroleptics, antidepressants, cholinolytics, etc. can be included in complex therapy. Elderly patients are recommended to take vascular and antisclerotic medications that improve cerebral and cardiac circulation. Of the physiotherapeutic methods of treatment, UHF, DDT, novocaine endonasal electrophoresis, mud therapy, facial and neck muscle massage are the most effective for ganglionitis of the wing node.
It should be noted that the complex treatment in most cases reduces the severity of clinical manifestations of the disease. However, not in all cases it is able to save patients from relapses of the disease.