Glossopharyngeal neuralgia

By : Francis prathyusha
•Definition: The glossopharyngeal nerve is the
ninth cranial nerve (9th).

glosso • comes from the Greek

"glossa", the tongue

pharynx • is the Greek for throat

•So the glossopharyngeal nerve is the nerve that

serves the tongue & throat.
Origin:
from the
brain stem
(medulla)
by 3 nuclei ;

1)Sensory
(solitary nucleus)

2)Motor
(nucleus
ambiguus) in medulla
SVE
&

3)Parasympathetic
(inferior salivary
nucleus)
• Branches:

• 1. Motor branch; for one muscle

(stylopharyngeus muscle).

• 2. Parasympathetic branch; for parotid gland

• 3.Sensory branches
3. Sensory
branches:

A-. Pharyngeal br; for

mucosa of
oropharynx.

B- Lingual br; for

general sensation
and taste of the
posterior 1/3 of
tongue.

C- Tonsillar branch;
for palatine tonsil
and soft palate

D- Carotid br; supply

carotid sinus and
carotid body.
The 12 cranial nerves including the
glossopharyngeal nerve, emerge from or enter the
skull, unlike the spinal nerves which emerge from
the vertebral column.

The glossopharyngeal nerve supplies the

tongue, throat, & one of the salivary glands (the
parotid gland).

Problems with the glossopharyngeal nerve

result in trouble in taste & swallowing
 Glossopharyngeal neuralgia

severe pain in (back of the throat, area near tonsils,

back of tongue, and part of the ear).

rare disorder

begins after age 40 and occurs more in men

its cause is unknown.

Rarely, the cause is a tumor in the brain or neck

GPN) is also called vagoglossopharyngeal
neuralgia

It s characterized by brief but intense pain on one

side of the throat, which may radiate within the
mouth or into the ear. Attacks are described as
sharp, stabbing or burning in quality. They may
occur spontaneously or be provoked by talking,
chewing, swallowing, coughing and yawning.
May be confused with pain emanating from TMJ
or masticatory muscles

The pain can be provoked by touching the lateral

aspect of the throat
This neuralgia can occur in conjugation with
trigeminal neuralgia

When the pain is felt more deeply in the ear region

–tympanic plexus neuralgia

The ear pain may be excruciating .

Such neuralgia may be indistinguishable from

geniculate neuralgia when that disorder occurs only
in the ear .

Precise differentiation may at times require under

local anesthesia and direct stimulation to determine
which nerve is involved.
 Three forms of GPN can be distinguished:
1. Typical GPN is usually caused by vascular
compression of the IXth and Xth cranial nerve
rootlets entering the lateral medulla
2. Atypical GPN involves a prominent associated aching
or burning pain in the involved side of the face.
3. Secondary GPN is caused by a tumor injuring the
glossopharyngeal nerve in the neck or base of the
skull . GPN is rarely associated with multiple-
sclerosis
 Diagnosis

DIAGNOSE: For the test, a doctor touches the back of the

throat with a cotton-tipped applicator. If pain results, the
doctor applies a local anesthetic to the back of the throat.
CLINICAL DIFFERENTIATION GLOSSOPHARYNGEAL

1. Masticatory pain has the clinical features of deep

somatic pain, where as glossopharyngeal neuralgia
is neuropathic
2. Masticatory pain is arrested or decreased by
immobilization of the mandible with a bite block. This
does not prevent triggering by tongue movement
and swallowing
3. Masticatory pain is not arrested by
application of a topical anesthetic to
the pharyngeal mucosa, but
glossopharyngeal neuralgia can be
if the trigger area is anesthetized.
Treatment
 DRUGS
TEGRETOL
Ex.
LIORESAL

DILANTIN NEURONTIN
A glossopharyngeal block

applying a local anesthetic

(such as cocaine) to the
back of the throat
(temporary relief).

peristyloid technique
PERMANENT RELIEF: surgery may be needed. The
glossopharyngeal nerve is separated from the artery that
is compressing it by placing a small sponge between
them
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