Glossopharyngeal neuralgia: causes, symptoms, treatment of Sicard syndrome

Glossopharyngeal nerve neuralgia is pathological changes in its activity caused by the development of a concomitant disease in adjacent areas.

Among the symptoms of glossopharyngeal neuralgia are pain, a failure in the process of salivation, and a violation of reflexes such as the pharyngeal and palatine. To eliminate discomfort, medication and physiotherapy are prescribed.

This disease is rarely diagnosed. The incidence of pathology is 16:10 million people. The most susceptible to nerve neuralgia are men who have reached the age of 40-50. In females, the disease is less common.

Glossopharyngeal nerve: anatomy and function

The origin of the glossopharyngeal nerve is the medulla oblongata. The nerve is formed by sensitive, motor, autonomic parasympathetic fibers. Sensitive fibers provide innervation to the mucous membrane of the tonsils, as well as the soft palate, pharynx, tongue, eustachian tube, tympanic cavity.

With the help of taste fibers, a person can perceive taste. Motor fibers innervate the stylopharyngeal muscle, which raises the pharynx. Palatine and pharyngeal reflexes are formed by motor and sensory fibers, as well as the vagus nerve.

The beginning of the parasympathetic fibers that forms the glossopharyngeal nerve is the lower salivary nucleus. Further, together with the tympanic and lesser petrous nerves, the fibers enter the ear vegetative ganglion, then into the parotid gland, ensuring the regulation of salivation.

The reasons for the development of pathology

Doctors distinguish primary idiopathic glossopharyngeal neuralgia and secondary - Sicard syndrome.

In most cases, glossopharyngeal neuralgia occurs against the background of other pathological conditions in the body. As a primary disease, pathology is extremely rare.

The defeat of the glossopharyngeal nerve is formed against the background of:

• the development of atherosclerosis, in which blood vessels are affected and local blood circulation is disturbed;
• infectious diseases such as tonsillitis or flu;
• intoxication syndrome resulting from exposure to heavy metals or other harmful substances;
• traumatic injury to the tonsils;
• anatomical features of the styloid process, for example, if its length exceeds normal;
• deposits of calcium salts in the stylohyoid ligament;
• the presence of a tumor-like neoplasm, concentrated in the section where the bridge connects with the cerebellum;
• the presence of a tumor formation in the laryngeal zone;
• otolaryngological pathology;
• compression of the nerve by muscles;
• pathologies of an inflammatory nature in the brain, its membranes;
• aneurysm in the vessel.

Given the source of the disease, conservative or surgical treatment is prescribed. If some pathologies can be corrected with medicines, then in the therapy of others they cannot do without the intervention of a surgeon.

The nature of the clinical picture

The pathological condition proceeds with acute pain symptoms, which is observed in the sub-root lingual region or in the area of ​​one amygdala. Pain syndrome with neuralgia is based not only in the area of ​​the glossopharyngeal nerve, it radiates to the soft palate, pharyngeal region, ear, sometimes the symptom gives to the eyes, jaw, neck.

The syndrome is unilateral. Duration - no more than 2-3 minutes. The intensification of the symptom occurs at the time of movement of the tongue, for example, while eating or talking loudly.

The mode of work and rest is violated: there is nocturnal insomnia due to severe pain. A person sleeps on one side, from the side of the absence of discomfort.

Among other characteristic symptoms, - increased dryness of the oral mucosa, and after the end of the attack - on the contrary, increased salivation. The produced liquid has a viscous consistency.

Sometimes glossopharyngeal neuralgia can provoke general symptoms:

• dizziness;
• the appearance of "goose bumps" in the eyes;
• hypotension (lowering blood pressure levels);
• rarely - fainting.

The latter symptoms appear due to irritation of a branch in the glossopharyngeal nerve, which depresses the vasomotor center of the brain and causes a drop in pressure.

Neurological pathology is characterized by exacerbation and remission. The remission stage can last long enough, sometimes reaching 1 year.

Over time, the development of pathology, periods with exacerbation of symptoms become more frequent, and pain symptoms intensify.

The sensitivity of those areas that are involved in the innervation of the glossopharyngeal nerve is impaired: tongue (posterior third), tonsil, pharynx on one side, soft palate, ear. Gustatory perception also gets confused.

Diagnostics and differential analysis

Initially, the doctor collects information about the duration of the onset of symptoms, their nature, and intensity. Differentiate the disease from trigeminal neuralgia - pathology that proceeds with similar clinical manifestations.

The main difference between these diseases is the area of ​​concentration of pain symptoms. If trigeminal neuralgia occurs with discomfort arising in the facial part (usually near the lips), then the affected glossopharyngeal nerve - with a symptom localized at the lingual root.

To identify a pathological condition, the following measures are prescribed:

• orthopantomogram (helps to identify an increase in the styloid process);
• computed tomography of the brain;
• magnetic resonance imaging of blood vessels.

A visit to an oncologist is required, which will help to exclude cancer.

Therapies

When the first alarming symptoms appear, it is recommended to consult a doctor; the earlier treatment is started, the more favorable the prognosis. Neuralgia requires long-term therapy, the method of which is determined taking into account the cause and severity of the disease.

Conservative treatment

Drug treatment of glossopharyngeal neuralgia consists in taking analgesic drugs (non-steroidal anti-inflammatory drugs), antiepileptic drugs, antipsychotics, muscle relaxants, vitamin complexes, fortifying.

With the ineffectiveness of oral drugs, the patient is given blockade by injection under the lingual area. Of the drugs for local exposure, anesthetics are used, for example, Dikain, which is used to lubricate the oral cavity.

Physiotherapy is often prescribed. This can be galvanized, diadynamic and sinusoidal currents.

Surgical intervention

During surgical manipulation, the affected nerve is released, which is compressed and irritated by the nearby tissue. Microvascular decompression of the nerve root is performed in the place where it leaves the brain. If necessary, the sublingual ligament is dissected and the styloid process is shortened.

Endoscopic microsurgical equipment is used. This reduces the risk of trauma to healthy tissues and the appearance of negative consequences.

In most cases, negative consequences arise against the background of an incorrectly performed operation, which may lead to secondary infection of the wound or additional injury to the affected area.

With the timely initiation of therapy and the implementation of all the doctor's recommendations, one can hope for a favorable prognosis and complete recovery.

Preventive measures

Until now, specific preventive measures have not been developed. It is important to direct efforts to prevent the development of provoking diseases (infectious, viral, etc.), to eliminate the risk of injury to the head and jaw bones.

Glossopharyngeal nerve neuralgia requires long-term and painstaking therapy, the duration of which can be up to several years, but the pathology is not one of the potentially dangerous diseases. However, you should not rely on self-medication alone. Otherwise, the recovery time is slowed down.