Скачать или смотреть SLUDER’S NEURALGIA //CORRECTION OF SEPTAL SPUR WITH CAUDAL DISLOCATION

Case Presentation

Patient Profile
• Age/Sex: 25-year-old male
• Chief Complaint:
• Recurrent right-sided facial pain and headache for several months
• Nasal obstruction, predominantly right-sided

History of Present Illness
• Facial Pain:
• Sharp, shooting, deep-seated pain around the right eye, cheek, and upper jaw.
• Episodes last minutes to hours, often triggered by cold air, nasal congestion, or exertion.
• Associated Symptoms:
• Nasal obstruction more on the right side.
• No epistaxis, anosmia, or purulent nasal discharge.
• No history of migraine or trigeminal neuralgia.

Examination

Anterior Rhinoscopy
• Right-sided septal spur impinging on the lateral nasal wall.
• Anterior caudal dislocation of the septum to the right.

Endoscopic Findings
• Contact point between septal spur and middle turbinate on the right side.
• Left caudal septal dislocation visible intraoperatively.

Neurological Exam
• Normal, except tenderness over infraorbital region.

Investigations
• Diagnostic Nasal Endoscopy → Confirmed septal spur and mucosal contact point.
• CT PNS → Deviated nasal septum with right anterior caudal dislocation; no sinus disease.

Diagnosis

Sluder’s Neuralgia secondary to right-sided septal spur with anterior caudal septal dislocation.

Management

Surgical Plan
• Endoscopic Septoplasty:
• Removal of right-sided septal spur.
• Correction of anterior caudal dislocation.
• Preservation of septal support.
• Intraoperative Findings:
• Right septal spur impinging on lateral nasal wall.
• Left-sided caudal dislocation corrected.

Postoperative Care
• Nasal packing for 24–48 hours.
• Saline irrigations, antibiotics, and analgesics.
• Avoid nose blowing and trauma.

Outcome
• Significant reduction in headache and facial pain within weeks.
• Nasal airway markedly improved.

Discussion
• Sluder’s neuralgia (sphenopalatine neuralgia) often arises due to septal spurs or mucosal contact points irritating branches of the sphenopalatine ganglion.
• Endoscopic septoplasty is effective when neuralgia is secondary to an anatomical contact point.
• Success rates are high (~70–80%) if the neuralgia is contact-point mediated.
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