Head and Neck: Sphenopalatine Ganglion Neuralgia Diagnosis and Treatment
by Edwin A. Ernest, III, DMD
 The autonomic features
often found to often be a part of the pain complex associated with the sphenopalatine
ganglion tend to confound the clinician attempting to diagnose the reason for the
patient’s headache that is typically described as a dull ache. Commonly, the person
suffering pain associated with the sphenopalatine ganglion also has dental symptoms,
characterized as aching tooth or teeth, with the adjacent gum tissue hurting as well. This
paper will describe the neuroanatomy and signs and symptoms common to the disorder, and
suggests testing of the ganglion when there is headache and/or dental pain that is
otherwise undiagnosed.
Neuroanatomy
The sphenopalatine ganglion—also known as pteryopalatine ganglion, Meckel’s
ganglion, Sluter’s ganglion and nasal ganglion—is the largest of the four
parasympathetic ganglia associated with the trigeminal nerve and consists of the largest
collection of neurons in the head outside of the brain and is the only ganglion exposed to
the environment via the nasal mucosa. It is found in the pteryopalatine fossa behind the
middle turbinate of the nose and is noted to be triangular in shape. The ganglion is
located just below the maxillary nerve as the maxillary nerve crosses the fossa. The
sphenopalatine ganglion receives three nerve roots: the sensory root from the
sphenopalatine branches of the maxillary nerve, the motor root derived from the nervus
intermedius which is a part of the facial nerve through the greater petrosal nerve, and
the sympathetic root, which consists of sympathetic postganglionic (efferent) fibers from
the superior cervical ganglion (see Figure 1).
The ganglion also has preganglionic parasympathetic fibers which synapse with neurons
whose postganglionic axons, vasodilator and secretory fibers are distributed with the deep
branches of the trigeminal nerve to the mucous membrane of the nose, soft palate, tonsils,
uvula, roof of the mouth, upper lip and gums, possibly teeth, and to the upper part of the
pharynx (see Figure 2). Postganglionic parasympathetic fibers also go to the lacrimal
gland via a branch of the maxillary nerve which then connects with a branch of the
ophthalmic nerve (lacrimal nerve) arriving at the lacrimal gland. The palatine nerves send
secretomotor fibers to the nasal glands and to the pharyngeal glands and all are branches
of the maxillary nerve.
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— March 2010
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