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Abstract
In 1908 Sluder described a symptom complex consisting of neuralgic, motor, sensory and gustatory manifestations that he attributed to the sphenopalatine ganglion. He stated that treatment directed at the ganglion successfully alleviated these symptoms. Over the last 90 years several reports have described patients as having sphenopalatine neuralgia and have directed treatment at the ganglion. The symptoms described and the criteria for patient selection in these studies has often been varied and deviated from Sluder's description. In reports claiming cures with treatment directed at the ganglion the duration of post-treatment follow-up has been short. This article discusses Sluder's description and attempts to analyse its features in the light of current understanding of the different mechanisms and categories of facial pain. It is proposed that the condition described by Sluder is a neurovascular headache that most closely resembles cluster headache in its aetiology and clinical manifestations. We propose that the term Sluder's neuralgia should be discarded as there are serious flaws in its original description and many authors have misused the term leading to persistent confusion about it.
Key words: Facial Pain Syndromes; Ganglia, Autonomie; Cluster Headache; Disease Management
Introduction
In 1908 Sluder observed that occasionally patients who recovered from a high-grade inflammatory reaction in the posterior ethmoid and sphenoid sinuses were left with a characteristic neuralgic picture.1 He described the syndrome as a sphenopalatine ganglion neuralgia2,3 which included a symptom-complex of neuralgic, motor, sensory and gustatory manifestations that he attributed to the extension of inflammation or the transmission of toxins into the sphenopalatine ganglion. He described an all encompassing entity, but never recorded a case presenting with a combination of all the signs and symptoms he described.2,3 Sluder lacked the benefit of both nasal endoscopy, current imaging techniques and the range of drugs available today.
Neurological features
Sluder described an ipsilateral pain that could be constant with exacerbations, cyclical or episodic. The pain was classically described as beginning at the root of the nose, spreading ipsilaterally in and around the eye, involving the upper jaw and teeth and sometimes the lower jaw and teeth. It occasionally extended beneath the zygoma to the ear and sometimes it affected the mastoid, but was nearly always most severe at a point about 5 cm posterior to...