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Definition, causes and treatment of Sluder neuralgia
Sluder neuralgia (also Sluder syndrome) is a controversial attempt to explain certain facial pain. The model was originally named after the American 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 is usually expressed in the area of the nose and eyes. So far, there are no clear diagnostic criteria, but the disease is mostly defined as a special form of cluster headache. This clinical picture is used to summarize periodic headaches that have no discernible connection with an existing disease. This makes diagnosis and treatment extremely difficult.
In order to describe the clinical picture, it is helpful to get a more precise picture of the affected body region and nerve pathways, which are probably the cause of the pain attacks.
Anatomy and physiology of Sluder neuralgia
A nerve node (ganglion) is located in the oral cavity in front of the temporomandibular joint, in the so-called wing palate (fossa pterygopalatina). Because of its proximity to the sphenoid bone (Os pterygoideum) and to the palate (Palatinum), it is called the pterygopalatine ganglion. The former name "ganglion sphenopalatinum" was derived from the proximity to a bone opening, which is called formane sphenopalatinum. The ganglion is a switching point for parasympathetic nerves. This part of the vegetative (autonomous) nervous system is responsible, among other things, for inward digestive and regeneration processes. In the pterygopalatine ganglion, the nerve fibers for the nasal, palate, pharynx and lacrimal glands and for the vessels of the face and brain are connected.
The explanatory model
Sluder was of the opinion that certain facial neuralgias cause reflex irritation of fibers of the trigeminal nerve (fifth cranial nerve, trigeminal nerve). He treated this by injecting alcohol into the ganglion. Although sensitive fibers extend from the second main branch of the trigeminal nerve (maxillary nerve) through the pterygopalatine ganglion, no exchange has taken place according to previous anatomical knowledge. Fibers of the vegetative nervous system from the ganglion, however, use the trigeminal nerve and its branches to direct the appropriate stimuli and impulses to their target organs.
The symptoms during a pain episode usually last no longer than 20 minutes and can be accompanied by sneezing fits. The affected regions of the body are predominantly on the face, but the pain in the neck, neck and shoulder can also radiate. Those affected most often suffer from pain in the areas of the inner corner of the eyelid, with the eyeball and nose or nasal root, as well as the upper jaw and palate. There may also be a decrease in sensation (hypesthesia) in the area of the mouth and throat or even paralysis of the soft palate on one side.
Causes and diagnosis
Sluder's attempt to explain the cause of a specific form of facial neuralgia has not been sufficiently validated to this day. There are different opinions as to whether Sluder syndrome should be defined as a separate disease in addition to cluster headache. Therefore, there are currently no separate diagnostic criteria.
Little is known about the development of cluster headaches and various causes are assumed. In most cases, the exact questioning of patients about the symptoms of the headache or facial pain that occurs forms the basis for the relatively difficult diagnosis. The symptoms are classified according to the "International Classification of Headache Diseases" (IHS Classification ICHD-II, currently ICHD-III). If the diagnosis of cluster headache follows from this, synonyms such as sluder neuralgia, neuralgia of the sphenopalatine ganglion or vidian neuralgia, as further possible variants of sluder neuralgia, are assigned.
In the differential diagnosis of trigeminal neuralgia (irritation of the trigeminal nerve), there are one-sided headache attacks with accompanying symptoms such as watery eyes. The second and third branches of the trigeminal nerve are often affected in this disease. This diagnosis comes very close to the description of Sluder neuralgia.
Due to the relatively short duration of the pain attacks, prophylactic treatment is in the foreground, with appropriate medicinal therapy being carried out first. If medication is unsuccessful, a surgical intervention for pain relief may also be considered. The exact course of treatment should be determined and accompanied by experienced experts.
A clear diagnosis is essential for a treatment success. This is problematic in Sluder neuralgia due to the lack of recognized diagnostic criteria. For cluster headaches and similar diagnoses, the Deutsche Migäne- und Kopfschmerzgesellschaft e.V. (DMKG) published a revised guideline in 2016 with therapy recommendations that are based on criteria of evidence-based medicine.
According to Sluder, the disease was previously treated by injecting alcohol into the ganglion. Even today, therapy is often used in which a (mostly non-prescription) local anesthetic is injected or applied to the nasal mucosa. This possibility is described in the neural therapy according to Hunke.
Due to the described cause of Sluder neuralgia, a ganglion in the area of the palate in front of the temporomandibular joint, a connection with the surrounding muscles of the temporomandibular joint is suspected. This also affects the so-called mouth closer muscles of the chewing muscles (pterygoideus muscle). In osteopathy, manual treatment uses loosening or balancing techniques so that the function of the ganglion may no longer be impaired or irritated by mechanical forces.
Craniosacral osteopathy involves the possibility of abnormal tension in the facial bones and sphenoid bone. In the fascia distortion model (FDM), in which the patient's body language is used for diagnosis and treatment, one often finds a stroke along a line, the so-called trigger band technique. However, it is difficult to check whether treatment is successful, among other things because the treatments are not taking place in the acute stage.
In contrast to headaches in general, the possibilities of naturopathy for cluster headaches are very limited. In this context, however, oxygen inhalation should be mentioned, one of the most frequently used forms of conventional medical therapy, which has a naturopathic approach. (tf, cs)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- Ahamed, S.H. / Jones, N.S .: What is Sluder’s neuralgia? The Journal of Laryngology & Otology, Volume 117, Issue 6, Cambridge University Press, 2003, cambridge.org
- Olszewska-Ziąber, Agnieszka / Ziąber, Jacek / Rysz, Jacek: Atypical facial pains - Sluder’s neuralgia - local treatment of the sphenopalatine ganglion with phenol - case report, Otolaryngologia Polska, Volume 61, Issue 3, 2007, sciencedirect.com
- Walter de Gruyter GmbH: Cluster headache (accessed: July 13, 2019), pschyrembel.de
- Mayo Clinic: Cluster headache (accessed: July 13, 2019), mayoclinic.org
- Göbel, Hartmut: The headache: causes, mechanisms, diagnostics and therapy in practice, Springer, 3rd edition, 2012
- German Society for Neurology (DGN): S1 guideline for cluster headache and trigeminal autonomic headache, as of May 2015, detailed view of guidelines
ICD codes for this disease: G44ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.