Sluder neuralgia

Definition, Causes and Treatment of Sluder Neuralgia

Sluder neuralgia (also called Sluder syndrome) is a controversial explanation of certain facial pains. The model was originally named after the US ear, nose and throat doctor Greenfield Sluder from St. Louis (1865-1908). Other synonyms such as pterygopalatine syndrome or sphenopalatine syndrome indicate the possible origin of the pain, which usually manifests itself in the nose and eyes. Clear diagnostic criteria are not yet available, however, the disease is usually defined as a special form of cluster headache. Under this disease is summarized periodic headache, which have no apparent relationship with an existing disease. This makes diagnosis and treatment extremely difficult.

contents

• Definition, Causes and Treatment of Sluder Neuralgia
• definition
• symptoms
• Causes and diagnosis
• treatment
• Naturopathic treatment

definition

To describe the clinical picture, it is helpful to get a more accurate picture of the affected body region and nerve tracts, which are probably the cause of the pain attacks.

Anatomy and Physiology of Sluder Neuralgia

In the mouth is located in front of the temporomandibular joint, in the so-called pelvic cavity (fossa pterygopalatina), a ganglion (ganglion). Because of its proximity to the sphenoid bone (os pterygoideum) and the palate (palatine) it is called ganglion pterygopalatinum. The former term "sphenopalatine ganglion" derived from proximity to a bone opening called formane sphenopalatineum. The ganglion is a switch for parasympathetic nerves. This part of the vegetative (autonomic) nervous system is responsible, among other things, for inward digestion and regeneration processes. In the ganglion pterygopalatinum the nerve fibers for the nasal, palatal, pharyngeal and lacrimal glands and for the vessels of face and brain are connected.

Sluder neuralgia is a possible explanation for recurrent, relatively short pain attacks in the nose and eyes. (Image: puhhha / fotolia.com)

The explanatory model

Sluder suggested that certain facial neuralgia may be subject to reflex irritation of trigeminal nerve fibers (fifth cranial nerve, trigeminal nerve). He treated this by injecting alcohol into the ganglion. Although sensitive fibers pass through the pterygopalatine ganglion from the second major branch of the trigeminal nerve (maxillary nerve), anatomical knowledge has shown that no exchange occurs. However, fibers of the vegetative nervous system from the ganglion use the trigeminal nerve and its branches to direct the corresponding stimuli and impulses to their target organs.

symptoms

Symptoms during a pain episode usually last no longer than 20 minutes and may be accompanied by sneezing. The affected areas of the body are predominantly in the face, but it can also come to radiations of the pain in the neck, neck and shoulder. Most often sufferers suffer from pain in the areas of the inner angle of the eyelid, with eyeball and nose or nose root, as well as the upper jaw and palate. There may also be a decrease in sensation (hypoaesthesia) in the area of ​​the oropharynx or even hemiparal paralysis of the soft palate.

Causes and diagnosis

Sluder's attempt to explain the cause of a particular form of facial neuralgia has not yet been sufficiently validated. There are divergent opinions as to whether Sluder syndrome, in addition to cluster headache, should be defined as a disease of its own. Therefore, there are currently no own diagnostic criteria.

Little is known about the development of cluster headache and various causes are assumed. In most cases, the exact questioning of patients on the symptoms of the occurring headache or facial pain forms the basis for the relatively difficult diagnosis. The symptoms are classified according to the "International Classification of Headache Disorders" (IHS classification ICHD-II, currently ICHD-III). From this, the diagnosis of cluster headache is followed by synonyms such as sluder neuralgia, neuralgia of the sphenopalatine ganglion or vidianus neuralgia, as further possible variants of sluder neuralgia.

Irritant conditions of the trigeminal nerve (fifth cranial nerve) probably lead to certain facial neuralgia. (Image: Henrie / fotolia.com)

The differential diagnosis of trigeminal neuralgia (stimulus condition of the trigeminal nerve) leads to unilateral headache attacks with accompanying symptoms such as watery eyes. This disease often affects the second and third branches of the trigeminal nerve. This diagnosis comes very close to the description of sluder neuralgia.

treatment

Due to the relatively short duration of pain attacks prophylactic treatment is in the foreground, whereby first a corresponding drug therapy is performed. If medications prove unsuccessful, surgery may be considered to relieve pain. The exact course of treatment should be determined and accompanied by experienced experts.
In principle, a clear diagnosis is fundamental for a treatment event. This is problematic in sludder neuralgia due to lack of recognized diagnostic criteria. For cluster headaches and similar diagnoses, a revised guideline was published in 2016 by the German Migraine and Headache Society e.V. (DMKG) with treatment recommendations based on criteria of evidence-based medicine.

Naturopathic treatment

After Sluder, the disease was previously treated by injecting alcohol into the ganglion. Even today, a therapy is often used in which a (usually non-prescription) local anesthetic is injected or applied to the nasal mucosa. This possibility is described in the Hunke Neural Therapy.

About neural and muscular connections in osteopathy is trying to bring about pain relief. (Image: karelnoppe / fotolia.com)

Due to the described cause of sludder neuralgia, a ganglion in the region of the palate in front of the temporomandibular joint, a connection with the surrounding muscles of the temporomandibular joint is suspected. This also applies to the so-called mouth-closing muscles of the masticatory muscles (pterygoid muscle). In osteopathy, manual treatment involves the use of loosening or balancing techniques, so that the mechanical function of the ganglion may no longer hinder or irritate the function of the ganglion.

Craniosacral osteopathy involves the possibility of abnormal tension of the facial bones and sphenoid bone. In the Fascial Distortion Model (FDM), which examines the body language of the patient in diagnosis and treatment, one often finds stroking along a line, the so-called trigger band technique. However, it is difficult to check a possible treatment success, among other things, because the treatments do not take place in the acute stage.

In contrast to headaches in general, the possibilities of naturopathy in cluster headaches are very limited. In this context, however, mention should be made of oxygen inhalation, one of the most frequently used conventional medical forms of therapy, which has a naturopathic approach. (tf, cs; updated 18/07/2018)