Neuralgia of the superior laryngeal nerve, symptoms and treatment. Inflammation of the laryngeal nerve symptoms

Neuralgia of the superior laryngeal nerve is a pathology that is accompanied by the appearance of paroxysmal pain during eating or swallowing, radiating to the ear area. To date, it has not been possible to identify the main cause that provokes the development of such a disease. It is believed that a predisposing factor to the appearance of neuralgia is severe hypothermia of the body and concomitant pathologies present in the patient.

Characteristics of the disease

With the development of a pathology such as neuralgia of the superior laryngeal nerve, the patient complains of unilateral pain localized in the throat. As the pathology progresses discomfort begin to radiate into the ear area and along lower jaw.

Mostly attacks occur during eating or during the act of swallowing, and provoke coughing and malaise throughout the body. The patient's pain point can be felt on the lateral surface of the neck above the thyroid cartilage.

The active development of such neuritis ends with the swallowing reflex completely disappearing or decreasing, and the sensitivity of the epiglottis is impaired. In addition, problems arise with the mobility of the affected part of the larynx, and this is complemented by pathological condition narrowing of the glottis.

Symptoms

Neuralgia of the superior laryngeal nerve is considered a cyclic disease in which acute stage replaced by periods of remission. The most characteristic symptom that occurs with this pathology is an attack of sudden pain. The duration of such spasms can vary and can reach 2-3 minutes.

An attack of neuralgia of the superior laryngeal nerve usually causes the development of the following symptoms:

sharp burning painful sensations arising in the larynx and angles of the lower jaw;
general weakness the whole body;
spread of pain in the area chest cells, hearing organs, collarbone and orbit;
decrease lumen vocal cords, that is, the development of laryngospasm;
gain spasms at any turn of the head.

A feeling of stiffness in the chest may indicate that a patient is developing an illness such as neuralgia of the superior laryngeal nerve. In addition, severe pain appears in the sublingual area, and spasms cannot be relieved with conventional non-narcotic medications.

Often, during attacks of neuralgia, the patient develops a cough, hiccups, and increased salivation. Swallowing, chewing and the desire to blow your nose are accompanied by increased pain, and a change in heart rate is also observed. The development of such disorders is associated with irritation vagus nerve.

Crash heart rate may signal that the disease is actively developing and the transition of neuralgia to the stage of neuritis is possible. In the absence effective therapy there may be problems with skin, that is, they begin to peel off greatly and turn red.

Causes of the disease

The problem of neuralgia of the superior laryngeal nerve in recent years special attention paid by many experts. Unfortunately, it has not yet been possible to find out the main reason that may provoke its development.

Doctors identify certain factors, the presence of which can cause the development of pathology:

age patient over 40 years old;
medicinal therapy individual drugs for a long time;
toxic exposure to bacteria and heavy metals on the body;
rare visit dentist;
frequent hypothermia body.

Often, neuralgia of the superior laryngeal nerve develops when the following diseases are present in the human body:

otitis and chronic sinusitis;
various types allergic reactions;
disruption cardiovascular systems;
syphilis;
tuberculosis;
HIV.

Often the development of neuralgia occurs when there is insufficient intake of B vitamins into the human body. In rare situations, spasms in the jaw and throat become the cause mental disorders in humans.

Diagnosis of pathology

In the absence of effective therapy, the initial stage of the disease proceeds quite rapidly. If you refuse treatment for long time, this often results in the development severe complications at the patient. When the pathology transitions to running form Problems with the functioning of the swallowing reflex gradually appear or it completely disappears.

To identify the cause that triggered the development of neuralgia, you should visit specialists such as an otolaryngologist and dentist. They will spend thorough examination the patient in order to exclude the presence of pathologies of his nose, ears and teeth.

With such a disease, consultation with an oncologist may be required if the attending physician suspects malignancy in the brain.

The final diagnosis is made taking into account anamnestic data and an objective examination, as well as based on the results of instrumental research methods. To determine functional state of the voice apparatus, diagnostic test methods can be carried out:

bronchoscopy;
computer tomography chest;
laryngoscopy;
MRI;
needle-shaped electromyography larynx.

A careful study of the diagnostic results allows us to identify the cause of neuralgia of the superior laryngeal nerve and select the most effective course treatment.

Treatment of pathology

When characteristic symptoms For such a disease, you should seek advice from a specialist and not self-medicate. The doctor will conduct comprehensive examination the patient and will pick up necessary treatment taking into account the stage of the disease and individual characteristics patient.

Neuralgia of the superior laryngeal nerve requires complex therapy, and on initial stages Once such a disease develops, it can be successfully treated. To eliminate this pathology, the following procedures can be performed:

reception medicinal anti-inflammatory drugs;
acupuncture.

In addition, various physiotherapeutic procedures are widely used, for example, phonophoresis or ultrasound. When identifying a disease at the very beginning of its development and purpose effective treatment Many complications can be avoided. In the event that neuralgia of the superior laryngeal nerve is provoked associated pathologies in the human body, they require mandatory treatment.

When such a disease is detected in people of speaking professions, voice rest must be prescribed for certain time. To the complex medical procedures, suggesting the sanitation of the resulting focus of pathology, low-frequency impulse currents, and also with low voltage.

The implementation of such treatment is determined by the stage of severity of discomfort, trophic changes in the mucous membrane and musculoskeletal system larynx.

To reduce pain, this is administered medicinal product like Novocaine certain types currents It is possible to perform electrophoresis with novocaine on lateral surface, inductothermy and darsonvalization.

To eliminate neuralgia of the superior laryngeal nerve, antiepileptic drugs, nonsteroidal anti-inflammatory drugs and antiplatelet agents are used.

Besides this, drug therapy can be supplemented by taking vitamins and using local anesthesia. It is often possible to get rid of painful paroxysm by lubricating the root of the tongue, pharynx and tonsils with a local anemetic.

Prognosis of the disease and complications

If the pathology is identified at the initial stages of its development, it can be successfully treated and within short time manages to get rid of characteristic symptoms. In the event that the patient for a long time does not seek help from a specialist, then consequences neuralgia of the superior laryngeal nerve can be quite dangerous.

When the disease progresses to last stage development, a disruption in the functioning of the swallowing reflex and even a complete loss of the ability to eat may occur.

At the very beginning of its development, neuralgia of the superior laryngeal nerve can be easily eliminated, so when the first signs appear, it is important to immediately seek help from a doctor. To eliminate this disease, it is important to carry out complex therapy and follow all doctor’s recommendations.

Neuralgia is a pain syndrome at the site of a nerve. Depending on the location of the nerve ending, neuralgia also has different names. For example, in the presence of pain, which is characterized by periodic “shooting” in the back of the head and symptoms of migraine, a disease such as occipital neuralgia should be suspected.

A distinctive characteristic of neuralgia from neuritis is the absence inflammatory reaction. Among neuritis, the nerve endings that run on the face and hands are most often affected, for example, the trigeminal nerve with classic symptoms.

Symptoms of neuralgia of the glossopharyngeal nerve are largely due to its structure, since this nerve has sensory, motor and parasympathetic fibers. The former are responsible for perception soft palate, pharynx, tonsils, taste qualities proximal tongue and epiglottis. As for the motor bundle, it controls the process of swallowing in the form of the pharyngeal reflex, and the work of the stylopharyngeal muscle. In turn, parasympathetic influence is observed in regulating the process of salivation.

The symptoms of neuralgia of the glossopharyngeal nerve are in many ways similar to neuralgia facial nerve. They are characterized by paroxysmal pain on one side of the root of the tongue, oropharynx and soft palate, especially when eating irritating solid foods (hot or cold), as well as when communicating, coughing or yawning. The center of neuralgia, where signals about nerve damage are received, is located in the brain and spinal cord.

The prevalence of the disease is quite low, the number of cases is increasing due to the male population. In most cases, neuralgia begins to bother people after 40 years of age.

Causes of neuralgia of the glossopharyngeal nerve

Neuralgia can manifest itself as independent disease or as symptoms or complications of another pathology. Among causal factors highlight:

Taking into account the causes of the disease, the treatment of glossopharyngeal neuralgia also has its own characteristics. Sometimes you can get by conservative methods, however some cases require surgical intervention, without which recovery will not occur.

Clinical symptoms of neuralgia

The disease can manifest itself acutely with increasing pain syndrome. Characteristic feature pain is considered to be prone to paroxysmal flow. The pain begins at the root of the tongue or in the tonsil area. It then spreads to the palate, oropharynx and ear. In addition, pain can be observed in the corner of the lower jaw, eye area or neck.

Each attack is quite short-lived and lasts approximately 2-3 minutes. The pain syndrome affects only one side. In addition to pain, a person feels dryness in oral cavity, which is replaced by increased secretion of saliva after an attack.

When palpating, unpleasant pain is observed in the area of the angle of the lower jaw, as well as in some areas of the outer ear canal. This is especially pronounced during an attack. Sometimes the pharyngeal reflex may be inhibited and the mobility of the soft palate may decrease, making it impossible to swallow saliva, water or food. Regarding taste sensitivity, then here the perception of all food with a bitter aftertaste is observed.

The course of the disease can occur with remissions and exacerbations. Symptoms of neuralgia of the glossopharyngeal nerve can be constantly disturbing in the form of a burning and twitching character near the root of the tongue or increase in intensity under the influence of any provoking factor, for example, a cough or a normal meal. In addition, the affected side of the face may acquire a hyperemic tint, and a frequent cough is a consequence of the sensation of a foreign body in the throat.

In addition to local clinical manifestations, are still observed general symptoms neuralgia of the glossopharyngeal nerve. Among them, it is necessary to focus on reducing systemic indicators blood pressure, disruption of the conduction of nerve impulses through the heart muscle with the onset of arrhythmia and other rhythm changes, as well as weakness in the muscles of the limbs and frequent loss of consciousness.

Exacerbation of the disease often occurs during low temperatures air (autumn, winter), which is replaced by remissions. Thus, neuralgia of the glossopharyngeal nerve is characterized by seasonality.

An attack of pain can be provoked by exposure to certain structures of the oral cavity. By irritating them, the intensity of the pain syndrome increases. These areas are located on palatine tonsils, arches and root of the tongue. During the period of remission, increased salivation may be observed.

Differential diagnosis of glossopharyngeal nerve neuralgia

Symptoms of glossopharyngeal neuralgia are for the most part similar to clinical manifestations of ganglionitis of the nodes of this nerve. The only evidence of ganglionitis is the presence of herpetic blisters in the pharynx and pharynx.

In addition, do not forget about neuralgia of the facial nerve, which can also manifest itself as pain on one side of the face, short attacks and difficulty swallowing. The difference is the location of trigger points on the face in the lip area, and in the case of neuralgia of the glossopharyngeal nerve, these zones are localized at the root of the tongue.

After analyzing the clinical picture and anamnesis of the disease for more precise definition Additional causes of the disease are used instrumental methods diagnostics:

X-ray examination. It can be used to detect hypertrophy of the styloid process or ossification of the stylohyoid ligament;
computer diagnostics of the brain allows you to detect pathology in bone structures;
magnetic resonance imaging provides visualization pathological processes in soft tissues;
Electroneuromyography is necessary to record disturbances in the conduction of nerve impulses.

Therapeutic measures for neuralgia of the glossopharyngeal nerve

Treatment of glossopharyngeal neuralgia consists of reducing the intensity or completely eliminating the pain syndrome. For this purpose, a solution of dicaine or other anesthetics is used, applied to the root of the tongue. This manipulation ensures the absence of pain for 6-7 hours.

If there is ineffectiveness or a shorter pain-free period, it is recommended to use novocaine by injection. One injection may require from 2 to 5 ml of a 1-2% solution. The injection site is located at the root of the tongue. In addition, the use of novocaine or trichlorethyl blockades at the carotid branching site is allowed.

In addition to injection methods of combating pain, they are widely used non-narcotic analgesics for oral administration.

Diadynamic and sinusoidal modulated currents are recommended among physiotherapeutic methods. Their point of application is the area behind the jaw, tonsils and oropharynx. The galvanization course is carried out using an anode located at the root of the tongue and a cathode located behind the jaw.

General therapeutic measures include the use of B vitamins, antipsychotics (aminazine) for intramuscular injection, as well as antiepileptic drugs (diphenin, finlepsin and carbamazepine - for oral administration.

To boost immune protective forces Vitamins, aloe extract, ginseng, ATP and many other restorative drugs should be used.

If the cause of neuralgia is an enlarged styloid process, then treatment consists of: surgical intervention, which implies its resection. If ineffective, it is necessary to resort to radiotomy, the level of which is located on the posterior cranial fossa, or to traco- and cordotomy.

Surgical treatment is based on releasing the nerve from compression and irritating effects of surrounding tissues. For this purpose, microscopic endoscopic equipment is used, which ensures a minimal risk of complications. It is used to remove the compressive factor near the exit from the brain stem.

Treatment of the disease takes a fairly long period of time, which can last for several years, but when used integrated approach complete recovery occurs.

Characteristics of the disease

With the development of a pathology such as neuralgia of the superior laryngeal nerve, the patient complains of unilateral pain localized in the throat. As the pathology progresses, unpleasant sensations begin to radiate to the ear area and along the lower jaw.

The active development of such neuritis ends with the swallowing reflex completely disappearing or decreasing, and the sensitivity of the epiglottis is impaired. In addition, problems arise with the mobility of the affected part of the larynx, and this pathological condition is complemented by a narrowing of the glottis.

Symptoms

Neuralgia of the superior laryngeal nerve is considered a cyclical disease, in which the acute stage is followed by periods of remission. The most characteristic symptom that occurs with this pathology is an attack of sudden pain. The duration of such spasms can vary and can reach 2-3 minutes.

An attack of neuralgia of the superior laryngeal nerve usually causes the development of the following symptoms:

sharp burning painful sensations arising in the larynx and angles of the lower jaw;
general weakness the whole body;
spread of pain in the area chest cells, hearing organs, collarbone and orbit;
decrease lumen vocal cords, that is, the development of laryngospasm;
gain spasms at any turn of the head.

An abnormal heart rhythm may indicate that the disease is actively developing and that neuralgia may progress to the stage of neuritis. In the absence of effective therapy, problems with the skin may appear, that is, they begin to peel off and turn red.

Causes of the disease

In recent years, many specialists have paid special attention to the problem of neuralgia of the superior laryngeal nerve. Unfortunately, it has not yet been possible to find out the main reason that may provoke its development.

Doctors identify certain factors, the presence of which can cause the development of pathology:

age patient over 40 years old;
medicinal therapy with certain drugs for a long time;
toxic exposure to bacteria and heavy metals on the body;
rare visit dentist;
frequent hypothermia body.

Often, neuralgia of the superior laryngeal nerve develops when the following diseases are present in the human body:

otitis and chronic sinusitis;
various types allergic reactions;
disruption cardiovascular systems;
syphilis;
tuberculosis;
HIV.

Often, the development of neuralgia occurs when there is insufficient intake of B vitamins into the human body. In rare situations, mental disorders in a person become the cause of spasms in the jaw and throat.

Diagnosis of pathology

In the absence of effective therapy, the initial stage of the disease proceeds quite rapidly. If you refuse treatment for a long time, this often results in the development of severe complications in the patient. When the pathology passes into an advanced form, problems with the functioning of the swallowing reflex gradually appear or it completely disappears.

To identify the cause that triggered the development of neuralgia, you should visit specialists such as an otolaryngologist and dentist. They will conduct a thorough examination of the patient in order to exclude the presence of pathologies of the nose, ears and teeth.

With such a disease, it may be necessary to consult an oncologist if the attending physician suspects a malignant tumor in the brain.

The final diagnosis is made taking into account anamnestic data and an objective examination, as well as based on the results of instrumental research methods. To determine the functional state of the vocal apparatus, diagnostic test methods can be used:

bronchoscopy;
computer tomography chest;
laryngoscopy;
MRI;
needle-shaped electromyography larynx.

A careful study of the diagnostic results allows us to identify the cause of neuralgia of the superior laryngeal nerve and select the most effective course of treatment.

Treatment of pathology

If characteristic symptoms of such a disease appear, you should seek advice from a specialist and do not self-medicate. The doctor will conduct a comprehensive examination of the patient and select the necessary treatment, taking into account the stage of the disease and the individual characteristics of the patient.

Neuralgia of the superior laryngeal nerve requires complex therapy, and in the initial stages of its development, such a disease can be successfully treated. To eliminate this pathology, the following procedures can be performed:

reception medicinal anti-inflammatory drugs;
acupuncture.

In addition, various physiotherapeutic procedures are widely used, for example, phonophoresis or ultrasound. By identifying the disease at the very beginning of its development and prescribing effective treatment, many complications can be avoided. In the event that neuralgia of the superior laryngeal nerve is provoked by concomitant pathologies in the human body, then mandatory treatment is required.

When such a disease is detected in people of speaking professions, voice rest is necessarily prescribed for a certain time. Low-frequency pulsed currents, as well as low voltage ones, are selected for the complex of treatment procedures that involve the sanitation of the resulting focus of pathology.

The implementation of such treatment is determined by the stage of severity of discomfort, trophic changes in the mucous membrane and motor apparatus of the larynx.

To reduce pain, a drug such as Novocaine is administered using certain types of currents. It is possible to perform electrophoresis with novocaine on the lateral surface, inductothermy and darsonvalization.

To eliminate neuralgia of the superior laryngeal nerve, antiepileptic drugs, nonsteroidal anti-inflammatory drugs and antiplatelet agents are used.

In addition, drug therapy can be supplemented by taking vitamins and using local anesthesia. It is often possible to get rid of painful paroxysm by lubricating the root of the tongue, pharynx and tonsils with a local anemetic.

Prognosis of the disease and complications

If the pathology is identified at the initial stages of its development, it can be successfully treated and in a short time it is possible to get rid of the characteristic symptoms. If the patient does not seek help from a specialist for a long time, then consequences neuralgia of the superior laryngeal nerve can be quite dangerous.

As the disease progresses to the last stage of development, disruption of the functioning of the swallowing reflex and even complete loss of the ability to eat may occur.

Translated from Greek language The term "neuralgia" means "nerve pain." This is a fairly common inflammatory process that affects approximately 5% of the total population of the planet. Neuralgia develops, as a rule, in nerves located in narrow openings and canals. Women are more susceptible to this disease than men. It is extremely rare that this diagnosis is given to children. Neuralgia, if it occurs in the superior laryngeal nerve, manifests itself as painful sensations, localized in the lower jaw and larynx. The etiology of this pathology is not fully understood, but experts identify a number of factors that provoke the development of characteristic symptoms of the disease.

Symptoms of neuralgia of the superior laryngeal nerve

The disease is cyclical. That is, attacks alternate with periods of remission. Obvious symptoms, which are accompanied by neuralgia of the superior laryngeal nerve - these are outbreaks burning pain. The duration of the spasms varies approximately from a few seconds to a couple of minutes. Attacks of neuralgia are characterized by the following features:

sharp, burning pain in the larynx and corners of the lower jaw;
laryngospasm (narrowing of the lumen of the vocal cords);
irradiation of pain to the chest, eye socket, ear, collarbone;
spasms intensify when turning and tilting the head;
attack of general weakness.

Symptoms such as constricting sensations in the chest area and pain in the sublingual area may also indicate that neuralgia of the superior laryngeal nerve is developing. Spasms cannot be relieved with conventional non-narcotic medications. Attacks of neuralgia are often accompanied by hiccups, coughing and increased salivation. The pain becomes more intense when swallowing, yawning or trying to blow your nose. Patients also experience changes in heart rate. These disorders are caused by irritation of the vagus nerve. The occurrence of an abnormal heart rhythm indicates the progression of the disease, the development pathological changes and the transition of neuralgia to the stage of neuritis. If left untreated, peeling and redness of the skin may occur.

Lit.: Big medical encyclopedia 1956

Many modern scientists are working on the problem of neuralgia of the superior laryngeal nerve. subject matter experts. However, the true cause of its occurrence has not yet been established. It is only known that there are factors that can provoke the development of this disease. The most common ones include:

age over 40 years;
systematic hypothermia (for example, frequent exposure to drafts);
recent visit to the dentist;
toxic effects of bacteria and heavy metals;
long-term use of certain groups of medications.

In addition, the symptoms that accompany neuralgia of the superior laryngeal nerve can provoke various diseases. These include the following:

Neuralgia of the superior laryngeal nerve can also be caused by a lack of B vitamins. Also in medical practice There have been cases where this disease was diagnosed in patients suffering from malabsorption useful substances, as well as bulimia and anorexia. Mental disorders are also often accompanied by spasms in the jaw and throat.

Which doctor treats laryngeal neuralgia?

It is worth saying that it is not possible to completely get rid of the disease. However, this does not mean that the disease should be left to chance. Frequent attacks of neuralgia of the superior laryngeal nerve can significantly affect a person: he becomes aggressive and irritable. This is how endless waiting for the next attack works. In some cases, neuralgia can even provoke depression or psychosis. Therefore, at the very first attacks, you should seek help from a specialist. The following doctors are involved in the diagnosis and treatment of neuralgia:

Very often to find out real reasons development of the disease, you should visit the offices of an otolaryngologist and dentist, as it is necessary to exclude diseases of the teeth, ears, and nose. You should also be prepared for the fact that you may need to consult an oncologist. His help is required in cases where there is a suspicion of a brain tumor.

At the appointment, the specialist must familiarize himself with clinical picture. To do this, he will carefully listen to the patient’s complaints and conduct a survey during which he will ask the patient the following questions.

Nasociliary neuralgia (Charlin's syndrome) occurs with sinusitis, inflammatory changes V paranasal sinuses nose pain, concha hypertrophy, deviated nasal septum, dental disease, influenza, chronic infections. Nasociliary nerve - branch optic nerve. This type of neuralgia is characterized by attacks of excruciating pain in the area of the eyeball or eyebrow, which radiates to the back and the corresponding half of the nose. Sometimes there is orbital and periorbital pain.

The pain occurs mainly in the evening, at night. The attack lasts up to several hours and even days. The pain syndrome is accompanied by lacrimation, photophobia, increased blinking, hyperemia, hyperesthesia, swelling of the nasal mucosa on the affected side, discharge of liquid secretion from one nostril, pain on palpation of the inner corner of the nasal cavity and half of the nose. There may be changes in the anterior part of the eye in the form of keratoconjunctivitis, iridocyclitis, scleral training. Differential- diagnostic sign neuralgia is the disappearance of all symptoms after iadocainization of the mucous membrane of the anterior nasal cavity with 2 ml of a 2% lidocaine solution.

Urgent Care. To relieve severe pain, use a mixture of analgin with diphenhydramine, seduxen, sodium hydroxybutyrate, aminazine. If the long ciliary nerves are damaged, 1-2 drops of a 0.25% dicaine solution are instilled into the eyes once a day. The pain syndrome is relieved after 2 - 3 minutes. To enhance the anesthetic effect, use a 0.1% solution of adrenaline hydrochloride (3 - 5 drops per 10 ml of dicaine solution). Instillation is prescribed for 5 - 7 days.

Neuralgia of the auriculotemporal nerve (Frey syndrome), or parotid-temporal hyperhidrosis, or auriculotemporal syndrome. The auriculotemporal nerve belongs to the third branch trigeminal nerve and contains sensory and secretory fibers for the ear ganglion. It innervates temporal region, the skin of the external auditory canal, the anterior parts of the auricle and is connected by anastomoses with the facial and other nerves. It is characterized by the appearance on the affected side in the area of innervation of the auriculotemporal (less commonly, greater auricular) nerve of skin hyperemia, sudden sweating in the parotid-temporal region and paroxysmal pain in the depths of the ear, in the anterior wall of the external auditory canal and in the temple area, especially in the temporal area - jaw joint. Often the pain radiates to the lower jaw. This kind of attack occurs when eating certain types of food (spicy, hard, sour, sweet, etc.), as well as in the presence of a number of external stimuli (hot room, noisy environment, etc.).

During these paroxysms, increased salivation is also observed, and often a change in the size of the pupil (first narrowing and then dilating) on the affected side.

Neuralgia of the auriculotemporal nerve is associated with injuries and past diseases parotid salivary gland inflammatory process, after surgery for mumps, when autonomic nerve fibers are involved in postoperative skin scars, etc.), leading to irritation of autonomic fibers running as part of the auriculotemporal and greater auricular nerves.

Urgent Care. Analgesics are prescribed in combination antihistamines, tranquilizers, neuroleptics, as well as vegetotropic drugs (Belloid, Bellaeton, Bellataminal), non-steroidal anti-inflammatory drugs (piroxicam, indomethacin, ibuprofen, naproxen, diclofenac, etc.).

To treat this disease, various types of physiotherapeutic procedures are recommended with iodine preparations, lidase, aloe injections, mud therapy, which promote the resorption of scar and adhesive formations in the area of the parotid salivary gland.

Neuralgia of the lingual nerve. Its occurrence is facilitated by infections, injuries, intoxication, vascular factors, etc.

Diagnosis is based on clinical data: the presence of attacks of burning pain in the area of the anterior two-thirds of the tongue, appearing spontaneously or provoked by eating very rough and spicy food, as well as actions associated with movements of the tongue (talking, laughing). Seizures may occur against the background chronic infection(tonsillitis, etc.), intoxication, prolonged irritation of the tongue by a prosthesis, sharp edge of a tooth, etc., more often in elderly people with the phenomenon of dyscirculatory encephalopathy. Sensitivity disorders (usually of the hyperesthesia type) are often detected on the corresponding half of the tongue; if the disease is long-standing, there is a loss of not only pain, but also taste sensitivity.

Urgent Care. During an attack, sedalgin, baralgin or analgin are prescribed per os (0.5 g 3-4 times a day) or intramuscularly 2 ml of a 50% analgin solution in combination with 1 ml of a 2.5% diprazine solution or 1 ml of 0.5% seduxen solution. The tongue is lubricated with a 1% solution of dicaine, or a 2% solution of novocaine, or a 2% solution of lidocaine. Subsequently, treatment of the underlying disease, sanitation of the oral cavity, vitamin therapy (vitamins B 1, B 12), and novocaine electrophoresis are carried out. In some cases, the use of anticonvulsants such as carbamazepine (finlepsin) is effective according to a scheme similar to the treatment regimen for trigeminal neuralgia (increasing the dosage from 0.2 g to 0.6 - 0.8 g, followed by a decrease to a maintenance dose).

Damage to the facial and intermediate nerve systems. Ganglionitis of the knee ganglion (neuralgia of the knee ganglion, Hunt's syndrome). Features of clinical manifestations: characterized by very strong paroxysmal pain in the ear area, radiating to the back of the head, face, and neck. lasting a few seconds. Herpetic eruptions appear in the area of innervation of the geniculate ganglion ( tympanic cavity, external auditory canal, auricle, auditory tube, palate, tonsils, uvula, often face and hairy part heads). There may be symptoms associated with impaired innervation of the facial nerve. There are taste disturbances in the anterior 2/3 of the tongue, sometimes hearing loss, ringing in the ears, dizziness, and horizontal nystagmus. Subsequently, hyperesthesia occurs in the area of the external auditory canal, tragus, anterior wall of the auditory canal, the anterior third of the tongue and the entire half of the face.

Urgent Care. Analgin, baralgin in combination with diphenhydramine (pipolfen, diprazine) are prescribed intramuscularly, ganglion blockers, tranquilizers (seduxen), antidepressants (amitriptyline), neuroleptics (aminazine), 10-15 ml of 1-2% novocaine solution are slowly injected intravenously.

Neuralgia of the Vidian nerve (Faille's syndrome). The Vidian nerve is a connection of the superficial greater petrosal nerve (branch VII cranial nerves) and deep petrosal nerve (branch of the sympathetic plexus of the carotid artery).

The reasons for his defeat are inflammatory processes in the paranasal sinuses and the apex of the pyramid, less often - injuries and metabolic disorders.

Features of clinical manifestations:

The pain syndrome is sympathetic in nature. The pain is paroxysmal, localized in the orbit, in the nasal cavity, radiating to the upper and (or) lower jaw, to the back of the head, since the Vidian nerve is connected to the pterygopalatine and geniculate ganglia.

The pain is localized in the orbit, but eyeball doesn't hurt.

The duration of the attack is from one to several hours, attacks often occur at night.

During an attack, pronounced autonomic reactions are observed (pallor of the face, hyposalivation).

Urgent Care. Prescribe painkillers (tramadol, analgin, baralgin, sedalgin, etc.) in combination with seduxen, non-steroidal anti-inflammatory drugs, ganglion blockers, antipsychotics and antidepressants. The underlying disease that caused the neuralgia is treated.

Damage to the glossopharyngeal and vagus nerve systems.

Neuralgia of the glossopharyngeal nerve (Weisenburg-Sicard-Robineau syndrome) develops with chronic tonsillitis, damage to the paranasal sinuses, teeth, various processes in the posterior cranial fossa, intoxication, enlarged styloid process.

It is characterized by attacks of pain that always begin at the root of the tongue, tonsils, and pharynx. They are provoked by eating, talking, coughing, pressing on the root of the tongue, pharynx, and tonsils. The pain spreads to the velum, ear, throat, sometimes radiating to the eye, angle of the lower jaw, cheek. The duration of painful attacks is 1-3 minutes, the intervals between them are not the same.

During an attack, a dry cough, taste disturbance, unilateral increased sensitivity in the posterior third of the tongue, and sometimes a decrease or absence of taste are noted. Loss of consciousness, decreased blood pressure due to inhibition of the vasomotor center, weakened mobility of the soft palate, hypergeusia to bitter in the posterior third of the tongue (all taste stimuli are perceived as bitter), and decreased pharyngeal reflex are rarely observed.

Some patients experience pain on palpation in the area of the angle of the lower jaw and certain areas of the external auditory canal during an attack. With symptoms of neuritis (neuropathy), hypoesthesia occurs in the upper third of the pharynx and the back of the tongue, the pharyngeal reflex decreases, a taste disorder appears in the back third of the tongue (hypergeusia to bitter), swallowing becomes difficult, salivation is impaired (dry mouth).

Urgent Care. Treatment is carried out according to the same rules as for trigeminal neuralgia central genesis. The most effective is carbamazepine, which gives a pharmacospecific analgesic effect, which is associated with an effect on central mechanisms painful neuralgic paroxysms. Prescribe non-narcotic analgesics in combination with seduxen, non-steroidal anti-inflammatory drugs, vitamin B 12. Lubricate the root of the tongue and pharynx with solutions of local anesthetic drugs; in severe cases, 2-5 ml of a 1-2% novocaine solution is injected into the root of the tongue; blockade with trichlorethyl or novocaine in the branching area is indicated carotid arteries. Diadynamic or sinusoidal currents are prescribed to the maxillary area. The underlying disease is treated and the oral cavity is sanitized.

Neuralgia of the superior laryngeal nerve(one of the branches of the vagus nerve) is characterized by unilateral pain of a paroxysmal nature in the larynx, radiating to the ear and along the lower jaw. It occurs during eating or swallowing. Sometimes attacks of laryngospasm develop. During an attack of pain, coughing appears, general weakness. Palpable pain point on the lateral surface of the neck just above the thyroid cartilage.

Neuritis leads to a sensitivity disorder in the epiglottis and a decrease or disappearance of the pharyngeal reflex over time. The affected half of the larynx turns out to be immobile, and the glottis may narrow.

Urgent Care. Analgesics are prescribed (2 ml of a 50% analgin solution) in combination with 1 ml of a 1% diphenhydramine solution or 1 ml of a 2.5% solution of diprazine (pipolfen) intramuscularly, novocaine - 10-15 ml of a 0.5% solution intravenously. If necessary, 2.5 - 5 mg of droperidol and 0.05 - 0.1 mg of fentanyl (thalamonal) are administered intramuscularly in a hospital setting.

Damage to the autonomic ganglia of the face.

Ganglionitis of the pterygopalatine ganglion (Slader syndrome). It occurs more often with damage to the paranasal cavities, mainly the main and ethmoid ones. Local inflammatory processes (rhinosinusitis, complicated caries, tonsillitis, otitis media), local trauma and common infections(usually ARVI, less often - rheumatism, tuberculosis, herpes zoster), as well as mechanical, allergic, constitutional and other factors that cause irritation of the pterygopalatine node.

Features of clinical manifestations: characterized by a combination of severe pain and autonomic disorders, to describe which the term “vetetative storm” is applicable.

The pain is sharp and begins spontaneously, often at night. Localized in the eye, around the orbit, in the root of the nose on one side, jaw and teeth. The pain spreads to the soft palate, tongue, ear, temporal and cervico-humeral region. At the same time, hyperemia of half the face and conjunctiva, profuse lacrimation and salivation, rhinorrhea from one half of the nose, swelling of the nasal mucosa, ear congestion, and a feeling of noise due to changes in the lumen and blood supply appear. auditory tube. A painful attack may be accompanied by shortness of breath, nausea, vomiting, photophobia, and muscle spasms of the soft palate. The duration of the pain syndrome ranges from several seconds to 1 - 2 days or more. The pain intensifies under the influence of sound and light. Paroxysms of pain often develop at night. After the attack, noise in the ear and paresthesia remain. Slader's syndrome differs from trigeminal neuralgia in the significantly longer duration of attacks, the zone of pain spread, the absence of trigger zones, the significant severity of autonomic disorders, and the development of painful paroxysms at night. An important diagnostic sign is the cessation of the attack after lubrication posterior sections nasal cavity with a 3% solution of lidocaine with adrenaline hydrochloride.