Ganglionitis of the wing node

Ganglionitis of the wing node is a pathology of the wing node, one of the varieties of vegetative ganglionitis and dental syndromes. It is also found under the name Slunder syndrome (on behalf of the American otolaryngologist who first described the disease). Another name is neuralgia of the wing node. The difficulty is that the clinical picture is very extensive. Ganglionitis of the wing node is most often manifested by facial pain (paroxysmal) and disorders of the autonomic system.

The content of the article:
Causes of ganglionitis of the wing node
Symptoms of ganglionitis of the wing node
Diagnosis of ganglionitis of the wing node
Treatment of ganglionitis of the wing node
Ganglionitis of the wing node
The pterygoid ganglion (node) is located in the pterygoid fossa and is formed from a branch of the trigeminal nerve. It consists of three roots:

somatic (trigeminal nerve);
parasympathetic (facial nerve);
sympathetic (plexus of the carotid artery, connected with the ear, neck nodes, nerve endings of the skull).
Causes of ganglionitis of the wing node
The wing node can be affected due to inflammatory processes in the sinuses of the upper or lower jaw (osteomyelitis), the lattice labyrinth of paranasal sinuses. The causes of this disease can also be toxic effects in tonsillitis, local damage (for example, foreign damage to the nose or its mucous membrane), the harmful effects of caries, purulent otitis media.

Any infectious foci in the oral cavity can become serious provocateurs of this disease. Overwork or lack of sleep, loud irritating sounds of a constant nature, stress, alcohol abuse or smoking act as provocateurs of arousal of the disease.

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

Symptoms of ganglionitis of the wing node
The disease lasts for a long time (months or years), severe exacerbations occur periodically (especially in the autumn-spring period, when the immune system is weakened, after stress or excitement).

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

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

Diagnosis of ganglionitis of the wing node
This disease is not easy to diagnose because of the similar clinical picture with other pathologies. For example, similar symptoms are observed in nasociliary nerve syndrome, Sikar syndrome, Charlene syndrome, migraine and temporal arteritis.

Ganglionitis of the wing node is important to distinguish from various types of facial neuralgia, in which pain of a shooting nature is also observed, but they are not accompanied by nausea or vomiting. Changes in the mucosa of the paranasal sinuses are very similar to the clinical picture of rhinitis and sinusitis. To exclude these diseases, turunds soaked in a weak solution of cocaine, dicaine or novocaine are injected into the nasal passages. A change in the nature of pain, its reduction, partial normalization of vegetative functions can confirm the diagnosis of ganglionitis of the wing node.

The complexity of the diagnosis of this disease is explained primarily by the fact that the wing node is associated with a variety of nerve structures that, when inflamed or excited, can give a variety of symptoms. When diagnosing this disease, the patient needs the advice of several doctors, except for a neurologist — otolaryngologist and dentist.

Treatment of ganglionitis of the wing node
The first task of a neurologist in the treatment of this disease will be to eliminate the inflammatory process in the nose, its paranasal sinuses, oral cavity, and teeth. For this purpose, anti-inflammatory, ganglioblocking agents are used. This is 1 ml of 2.5% benzohexonium solution intramuscularly, 5% pentamine. Injections are given three times a day for a month.
After the elimination of pain syndromes, drugs are prescribed for the general strengthening of the patient’s body, for example, vitamins B1, B6, B12, aloe, vitreous (immunotherapy). Sedatives are also mandatory.
To relieve severe pain syndrome, in case of ineffectiveness of conservative therapy, the anesthetics trimecaine or lycocaine are used. In this case, the injection is made directly into the palatine canal. If parasympathetic symptoms are observed in the clinical picture, platyphilin, antispasmodin are attributed. In some cases, the use of glucocorticoids or hydrocortisone phonophoresis (options for physiotherapy treatment) is prescribed.
If the disease has developed as a result of inflammatory processes, then anti-infective therapy in the form of antibiotics or sulfonamides is used. Desensitizing drugs (diphenhydramine, pipolfen) serve as the background of treatment.
To improve the general well-being of the patient, vasodilating anti-sclerotic drugs are attributed, injections are made to improve cerebral and general circulation.
In severe cases of the disease, radical treatment is used in the form of direct destruction of the wing node.
This can be done in one of two ways:

Puncture of the wing canal from the oral cavity. This method is complicated in the technique of execution and can have serious consequences for the patient;
Puncture of the cranial node in the cranial fossa with access from under the zygomatic arch. In this method, a phenol solution in glycerin and a concentrated alcohol solution (96%) are injected into the wing node.
Relapses of the disease do not always disappear as a result of treatment, but the clinical picture changes significantly. Many symptoms disappear or appear much less frequently. Treatment should be comprehensive, adequate and timely, only in this case a positive result is possible.

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