glossopharyngeal neuralgia
Introduction
Introduction to glossopharyngeal neuralgia Glossopharyngeal neuralgia, also known as glossopharyngeal convulsions, is rarely seen clinically; it is confined to the synovial lingual branch of the glossopharyngeal nerve, sometimes accompanied by recurrent episodes in the distribution of vagus nerve branches and pharyngeal branches. A sore or stinging pain. It is characterized by tonsil, paroxysmal pain in the posterior pharynx, in the back of the tongue and in the middle ear. The disease can be spontaneous, but often occurs by swallowing, talking, or touching the back of the tonsils. Can be divided into primary and secondary. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: hypotension, syncope, trigeminal neuralgia
Cause
Cause of glossopharyngeal neuralgia
(1) Causes of the disease
The cause of primary glossopharyngeal neuralgia is mostly unknown. Some patients have a history of sensation before onset. It is generally believed that due to the demyelination of the glossopharyngeal nerve and the vagus nerve, a short circuit between the afferent impulse of the glossopharyngeal nerve and the vagus nerve is caused. Painful convulsions in the glossopharyngeal nerve.
The cause of secondary glossopharyngeal neuralgia:
1. Intracranial glossopharyngeal nerve damage, may have cerebellopontine angle and posterior fossa tumor, epithelioid tumor, local infection, vascular disease, jugular vein hyperosteogeny, glossopharyngeal neurodegeneration.
2. Extracranial gutular nerve damage, may have too long styloid process, nasopharynx and tonsil tumor, chronic tonsillitis, tonsil abscess.
(two) pathogenesis
When a "short circuit" occurs between the glossopharyngeal nerve and the vagus nerve, a slight tactile stimulus can be transmitted to the center through the short circuit, and the impulse transmitted from the central center can also be transmitted to the center through the short circuit. When these impulses reach a certain sum, they can be excited. Upper ganglion and rock ganglion, nerve roots produce severe pain. In recent years, neurovascular decompression has been performed. It is found that vertebral artery or posterior inferior cerebellar artery of patients with glossopharyngeal neuralgia is compressed on the pharyngeal and vagus nerves, and the symptoms are relieved after compression. The glossopharyngeal neuralgia of these patients may be related to vascular compression. A group of 30 patients with neurovascular decompression in the treatment of glossopharyngeal nerve in the country, intraoperative observation showed that the jugular vein area has a thickening of arachnoid adhesion and wrapped the glossopharyngeal nerve. Root, glossopharyngeal nerve and posterior inferior cerebellar artery adhesion, 20 cases were affected by compression; 4 cases of vertebral artery compression; 3 cases of posterior inferior cerebellar artery + venous compression; 3 cases of multiple vascular stenosis (complex) compression All the compression vessels were within 5 mm from the lingual pharyngeal nerve root, and the arachnoid membrane was separated sharply. The pain disappeared immediately after decompression of the nerves and blood vessels, confirming the ectopic vascular pressure. It is closely related to the onset of glossopharyngeal neuralgia. The glossopharyngeal nerve root is in and out of the pons, that is, the transition zone between the central and peripheral nerves. There is a section of nerve-deficient Schwann cells wrapped, with an average length of 2 mm, referred to as the demyelinating zone. At the site of vascular pulsating compression, paroxysmal pain in the distribution of the glossopharyngeal nerve may occur, and the cause of pressure on the root of the glossopharyngeal nerve may be caused by various conditions. In addition to vascular factors, it also causes chronic inflammation stimulation around the cerebellopontine angle. Related, chronic irritating arachnoid inflammatory changes gradually thicken, so that the blood vessels and nerve roots abut each other, contributing to the process of nerve compression, because the nerve roots are thickened by arachnoid adhesion, arterial blood vessels are also ectopically affected by adhesion However, it is fixed in the sensitive area of the nerve root, causing nerve compression and impact without a buffer. The root of the glossopharyngeal nerve and the nearby blood vessels are the anatomical basis of the disease, while the arachnoid thickening adhesion in the internal jugular vein area causes the tongue. The unreasonable root of the pharyngeal nerve is the pathological basis of its arterial pulsation.
The pathogenesis of secondary glossopharyngeal neuralgia, mostly due to infection or tumor damage to the glossopharyngeal nerve, usually accompanied by signs of adjacent nerve involvement, solitary tract of medulla oblongata receives taste fibers from the facial nerve and the glossopharyngeal nerve Will be damaged by vascular lesions or tumors of the brain stem, because the glossopharyngeal nerve, vagus nerve and accessory nerve - from the jugular vein to the cranium, the tumor in this part causes multiple cranial nerve palsy (jugular vein syndrome), The area innervated by the glossopharyngeal nerve is also the extent of involvement of glossopharyngeal neuralgia. In most cases, there is no obvious pathological change of the glossopharyngeal nerve in glossopharyngeal neuralgia.
Prevention
Glossopharyngeal neuralgia prevention
The jugular vein area, skull base, nasopharynx, tonsil and other tumors and local arachnoiditis or aneurysm secondary disease, should pay attention to change bad habits, such as: irregular life, smoking, drinking, partial eclipse Eat particularly irritating, excessively greasy food, etc. Some medicines and foods can play a certain preventive effect. For example, genetic food prevention is currently prevalent in foreign countries and basically matures.
Timed examination is very important. The information received from the physical examination center every year shows that the tumor discovery rate is 1% to 5%. That is to say, 1 to 5 people may have tumors among 100 people who have undergone physical examination. Symptoms and signs, "Many people excuses work and do not pay attention to physical examination. In fact, early tumors often have obvious symptoms, which are easily overlooked. Once they are found in the middle and late stages, they miss the best time for treatment. In addition, they need to provide A good physical examination environment, improve the professional level of some grassroots personnel, and truly make early detection and early treatment of tumors.
Complication
Glossopharyngeal neuropathy Complications hypotension syncope trigeminal neuralgia
Severe patients may have uncomfortable cough, throat, excessive salivation, bradycardia, hypotension, syncope and other vagal hyperactivity. Some patients have trigeminal neuralgia.
Symptom
Symptoms of glossopharyngeal neuralgia Common symptoms Extracranial headache, severe pain, persistent pain, Tongue tremor, ear sputum, throat, tinnitus, ear pain, vertigo
Often starting after the age of 35, men are more common than women. Sudden pain, similar in nature to trigeminal neuralgia, located in the tonsils, tongue roots, pharynx, deep ear canal, etc., intermittent, each time lasts for a few seconds to 1-2 minutes, can be induced by swallowing, speech, cough, yawning, etc. There may be pain trigger points in the posterior pharyngeal wall, the base of the tongue, and the tonsil socket. Some cases may be accompanied by throat spasms, heart rhythm disorders, hypotension and fainting.
Clinically, the symptoms of glossopharyngeal neuralgia can be basically divided into the following points:
1. Good age: 35-50 years old.
2. The location of the disease: the tonsil area, the pharynx, the base of the tongue, the neck, the deep part of the ear canal, and the posterior mandibular area.
3. The nature of pain: paroxysmal severe pain, such as knife cut, jab-like, painful convulsions.
4. Pain time: frequent in the morning and morning, there may be seizures during sleep, which can be differentiated from trigeminal neuralgia.
5. Foreign body sensation and infarction: There is a foreign body sensation and infarction in the throat and throat during the onset, which causes frequent coughing.
6. Pain stimulating factors: palpation can cause pain, also known as "trigger point." Common in the tonsil area, external auditory canal, tongue root. Pain can be induced every time you swallow, chew, yawn, or cough.
7. There is a pause period.
8. The patient has dehydration and weight loss. It is caused by fear of pain and less food intake.
9. Severe cases may have arrhythmia, cardiac arrest, fainting, convulsions, seizures, throat, excessive secretion of the parotid gland.
Examine
Examination of glossopharyngeal neuralgia
Laboratory inspection
1. Blood routine, blood electrolytes generally have no specific changes, and the blood picture can be slightly higher when the disease occurs.
2. Blood sugar, immune items, cerebrospinal fluid examination, if abnormal, there is a differential diagnosis.
Film degree exam
Angiography, CT and MRI examinations: Some patients can find skull-shaped deformed blood vessels.
If the following items are abnormal, there is a differential diagnosis.
1. EEG, fundus examination.
2. Skull base film.
3. Chest, ECG.
Auxiliary inspection
1. The early detection of the disease is based on the inspection of the frame "A".
2. For patients with arrhythmia, convulsions, fainting, throat, and diphtheria, tetanus, poisoning, etc., and those who intend to exclude intracranial lesions, the examination project may include "A" and "B" within the inspection frame. , "C".
Diagnosis
Diagnosis and differential diagnosis of glossopharyngeal neuralgia
diagnosis
According to the nature and characteristics of the pain episode, it is not difficult to make a clinical diagnosis of the disease. Sometimes, in order to further confirm the diagnosis, it can stimulate the "trigger point" of the tonsil fossa, depending on whether it can induce pain, or spray the posterior pharyngeal wall with 1% tetracaine. If the tonsil fossa and other places can suppress the seizure, it is enough to confirm the diagnosis. If the pain in the pharynx disappears after the above drugs are sprayed, but the ear pain is still as before, the jugular foramen can be closed. It is indicated that patients with persistent pain or positive neurological signs should be considered for patients with persistent pain or positive neurological signs not only for glossopharyngeal neuralgia, but should be considered as secondary glossopharyngeal neuralgia. Further examination should be made to determine the cause.
Differential diagnosis
Clinically, it should be differentiated from trigeminal neuralgia, laryngeal neuralgia, kyphosis, pterygopalatine, cervical myositis and skull base, nasopharynx and cerebellar pons tumor.
1. Trigeminal neuralgia: The pain characteristics of the two are completely similar to the episodes, and the site is adjacent to it. The third pain is easily confused with glossopharyngeal neuralgia. The difference between the two is: trigeminal neuralgia is located in the trigeminal nerve distribution. District, the pain is shallower, the "trigger point" in the sputum, lips or nose, talking, washing, shaving can induce pain episodes; glossopharyngeal neuralgia is located in the glossopharyngeal nerve distribution area, the pain is deeper, "trigger point" In the posterior pharynx, tonsil socket, tongue root, chewing, and swallowing often induce painful episodes.
2. Upper laryngeal neuralgia: deep pain in the throat, tongue and upper throat, can be radiated to the ear area and gums, can be induced by talking and swallowing, there is tenderness point between the big corners of the hyoid bone, and 1% tetracaine cotton is used. The patch is applied to the piriform fossa and the large angle of the hyoid bone, or closed with 2% procaine nerve, which can completely prevent the pain from being identified.
3. Knee ganglion pain: Deep pain in the ear and mastoid area is often accompanied by ipsilateral paralysis, tinnitus, deafness and dizziness. Herpes can occur in the anterior traumatic area, the mastoid area and the anterior pharyngeal column, and the pain persists. Sexual, occipital ganglion pain, does not induce pharyngeal pain when chewing, talking and swallowing, but can induce pain episodes when slamming facial nerves, no "trigger point".
4. sphenopalatine ganglion pain: the clinical manifestations of this disease are mainly in the nasal roots, periorbital, teeth, facial and facial paroxysmal severe pain, its nature is like knife cutting, cauterization and acupuncture, and to the jaw , occipital and ear and other radiation, several times a day to dozens of times, each time lasts for several minutes to several hours, pain is often accompanied by tears, runny, photophobia, dizziness and nasal resistance, sometimes tongue The first 1/3 of the sense of taste is reduced, the upper limbs are weak, there is no obvious incentive for pain, and there is no "trigger point". The 1% tetracaine cotton is used to anesthetize the middle turbinate and the upper sphenopalatine ganglion. After 5-10 minutes, the pain can be disappear.
5. Cervical muscle inflammatory pain: a history of cold and fever before onset, single or multiple neck muscle inflammation, causing neck or pharyngeal pain, limited movement, local tenderness, sometimes radiated to the outer ear, with dicaine spray The pharyngeal mucosa can not relieve pain.
6. Secondary glossopharyngeal neuralgia: Skull base, nasopharynx and cerebellar ganglion mass or inflammation can cause glossopharyngeal neuralgia, but most of the persistent pain is accompanied by other cranial nerve disorders or other nerves. Departmental signs, X-ray skull base film, head CT scan and MRI examinations help to diagnose the cause.
