Charlin's syndrome – a complex of the symptoms caused by neuralgia of a nazotsiliarny nerve. The clinical picture at height of an attack is presented by a pain syndrome which is localized in an eye-socket and extends to face skin, the raised dacryagogue, a photophobia, plentiful allocations and feeling of a congestion of a nose. Diagnostics is based on carrying out biomicroscopy, an oftalmoskopiya, forward rinoskopiya, MRT of the head, diagnostic test with lidocaine. At a neuralgic form tactics of treatment comes down to use of antiepileptic medicines and anesthetics. The Giperpatichesky option demands the combined purpose of NPVS and lidokainovy spray.
Charlin's syndrome (disease of a nazotsiliarny nerve) was for the first time described in 1931 by the Chilean ophthalmologist K. Charlin. Prevalence of a disease in the general structure of diseases of ENT organs makes 1:25 000 population. At 4,1% of patients pain in a face is caused by pathology of a nosoresnichny nerve. The first clinical manifestations develop at the age of 35-40 years. Isolated cases of emergence of symptomatology in the neonatal period are described. 70,7% of patients note autumn and winter seasonality of development of attacks. Representatives of men's and female are ill with an identical frequency. Geographical features of distribution are not studied.
Reasons of a syndrome of Charlin
The etiology of a disease is directly connected with neuralgia of a nosoresnichny nerve. Often the syndrome develops against the background of syphilis, tuberculosis, metabolic frustration, flu. Act as the causes of pathology:
- Hypertrophy of an average nasal sink. There is a sdavleniye of nervous fibers the increased nasal sink that leads to defeat of terminal branches. In most cases this pathology is risk factor of development of a giperpatichesky form of a disease.
- Nose partition curvature. Anatomic the caused narrowing of the nasal course leads to violation of branching of nervous fibers that is shown by stable clinic of a disease.
- Adenoidny vegetations. Increase at a rate of a pharyngeal almond becomes the reason of the compression of a nervous trunk which is followed by the expressed pain syndrome and typical symptomatology from an organ of vision.
- Focal infections. Development of neuralgia is often connected with distribution of pathological process with a number of the located infection centers (caries, sinusitis).
- Traumatic damages. Can lead injuries of front department of a skull or an eye-socket which occur in life and at non-compliance with safety rules for conditions of production to neuralgia.
- Yatrogenny influence. The disease develops in the late postoperative period at patients to whom surgical interventions because of diseases or anomalies of development of ENT organs were carried out. Intraoperatsionno often damages terminal nervous branches that leads to the erased giperpatichesky option.
- Chronic inflammatory processes. At a chronic inflammation of a maxillary bosom there is a high risk of secondary damage of a nosoresnichny nerve that it is shown by typical clinic of a syndrome of Charlin.
The leading role in the mechanism of development is assigned to damages of a nosoresnichny nerve. The Nazotsiliarny nerve is the largest branch which departs from the first branch of a trunk of a trigeminal nerve. Long and short nervous fibers innervate an eyeball. The forward trellised nerve provides an innervation of a mucous membrane of forward department of a lateral wall of a nasal cavity, integuments of wings and a top of a nose, back – a mucous membrane of a wedge-shaped and back wall of a bosom of a trellised bone. Against the background of so extensive zone of an innervation at neuralgia of a nazotsiliarny nerve there is a number of symptoms which are at first sight not connected among themselves.
Charlin's syndrome – the acquired pathology. Congenital cases are not described, however in some cases it is possible to track genetic predisposition to development of a disease. From the clinical point of view the disease is classified on the following forms:
- Typical neuralgic. Develops at damage of the main nervous trunk, it is shown by classical symptomatology of neuralgia. At most of patients it is possible to reveal trigger points.
- The erased giperpatichesky. Arises at defeat of small trailer branches. Atypical neuropathic feelings among which the giperpatiya and a dizesteziya dominate are characteristic of this option. The trigger point cannot be found, however there are gipesteziya zones.
Symptoms of a syndrome of Charlin
The long time a disease proceeds in a latent form, the clinical symptomatology is absent. Then patients note sudden emergence of pristupoobrazny pain in the field of the orbit irradiating to the okologlaznichny area, the corresponding half of the face. Patients often connect emergence of an attack with irritation of a sidewall of a cavity of a nose which is observed during the squeezing of a wing of a nose, meal. The average duration of a pain syndrome makes 10-60 minutes, seldom pain lasts for weeks. In the mezhpristupny period the symptomatology is absent. Patients report that pains are projected only to the area of an eyeball or there is a diffusion morbidity of all half of the face. The aggravation of a pain syndrome can be followed by dispepsichesky frustration (nausea). In rare instances at the height of an attack there is vomiting.
Complaints to the raised dacryagogue, photophobia, are characteristic of pathology. Patients note emergence of plentiful allocations and feeling of a congestion of a nose. On the party of defeat the giperesteziya of integuments is found. Formation of the small bubbles filled with serous contents and reminding herpetic rashes is possible. Over a nostril and in the field of a verkhnevnutrenny corner of an orbit there is a feeling of strong burning. The conjunctiva is hyperemic. Expressiveness of symptoms not always correlates with severity of organic changes. The disease is followed by scattered neurologic symptomatology. More than 50% of patients note lability of arterial pressure. The long course of a disease significantly reduces quality of life and level of social adaptation of patients.
Forward ekssudativny uveit at a syndrome of a nazotsiliarny nerve becomes complicated a serous otsloyky retina and hypostasis of a disk of an optic nerve. Violation of an innervation of a forward segment of an eye leads to a kseroftalmiya. Patients are subject to risk of development of bacterial and infectious complications (conjunctivitis, keratit, Irit). At deterioration in an innervation of a mucous membrane of a nasal cavity on the extensive site the probability of decrease in sense of smell is high (anosmiya). The widespread complication – atrophic rhinitis, rinosinusit. Pathology is followed by development of a dismimiya which is not connected with dizembriogenetichesky stigmata.
Diagnosis is based on anamnestichesky yielded, results of fizikalny survey and special methods of inspection. The main diagnostic test is presented by a lidokainization of a mucous membrane of forward departments of a nasal cavity. Test is considered to be positive if it is possible to stop a pain syndrome within two minutes. Tool methods of diagnostics include:
- Eye biomicroscopy. Conjunctiva hyperaemia is visualized. On the surface of a cornea degenerate and dystrophic changes up to formation of deep ulcer defects are found.
- To Oftalmoskopy. At survey of an eye bottom signs of defeat of a uvealny path in the form of an exudate congestion in a back segment, the melkotochechny centers of hemorrhages are defined.
- Forward rinoskopiya. Hyperaemia and puffiness of a mucous membrane in forward departments of a nasal cavity is noted. At the long course of pathology atrophy zones are formed.
- Head MRT. Allows to reveal area in which integrity of nosoresnichny nervous fibers is broken. The magnetic and resonant tomography often gives the chance to visualize the pathological centers and to establish a disease etiology.
Differential diagnostics is carried out with neuralgia of a krylonebny or ciliary texture. At the isolated damage of ciliary knot (Oppengeym's syndrome) defeat symptoms only from an eye are observed. Distinctive feature of neuralgia of krylonebny knot – localization of pathological changes in back department of a cavity of a nose. Treatment of pathology is performed by the neurologist. Consultation of the ophthalmologist and otolaryngologist is in addition shown.
Treatment of a syndrome of Charlin
All patients need to carry out sanitation of the regionarny centers of an infection. Etiotropny therapy of the main disease allows to stop symptoms of a disease of Charlin. Conservative therapy of a typical neuralgic form is based on application:
- Anti-epileptic means. Carbamazepine has the expressed analgeziruyushchy effect at neuralgia of a nosoresnichny nerve. Reduction in the rate of synoptic transfer of an impulse is the cornerstone of the mechanism of action.
- Local anesthetics. Local use of solution of lidocaine is shown. Medicine has the expressed mestnoanesteziruyushchy effect. If necessary medicine can be applied in the instillyatsionny way.
If the cause of illness is covered in local changes of a cavity of a nose, then for elimination of a pain syndrome the mucous membrane of the lower nasal sink is greased with solutions of anesthetics in a combination with adrenaline. In treatment of the erased giperpatichesky form are used:
- Nonsteroid resolvents (NPVS). Medicines allow to stop local inflammatory changes, to reduce expressiveness of a pain syndrome. Are applied in the form of nasal spray and eye drops. At low efficiency of oral NPVS glucocorticosteroids are appointed.
- Lidokainovy spray. Regardless of an etiology daily instillations of spray are carried out to the struck half of a nose. Duration of use of medicine has to make not less than 5 days.
At all forms of a disease to patients vitamin therapy is appointed. Reception of vitamins of group B, P, C is shown. At insufficient efficiency of the main treatment expediency of additional use of medicines from groups is proved:
- Serotoninergichesky medicines. Purpose of selective agonists of serotoninovy receptors allows to stop attacks of a pain syndrome. Vozmozhet oral or intranazalny way of introduction of a medicine.
- Blockers of calcic channels. Medicines block receipt of ions of calcium in cages that reduces their threshold of excitability. Are used for the purpose of prevention of repeated attacks.
- Ganglioblokatorov. Medicines from the N-holinolitikov group affect receptors of a postsynaptic membrane, interfere with passing of a nervous impulse and prevent development of a pain syndrome.
At the chronic course of a disease physiotherapeutic methods are applied. To patients the nasal electrophoresis with solution of novocaine, a platifilin or atropine is carried out. Efficiency of application of a fonoforez with anesthetics and glucocorticosteroids is proved. Purpose of galvanization to a defeat zone is possible.
Forecast and prevention
The forecast for life and concerning visual functions favorable, but a heavy course of disease considerably worsens quality of life of the patient. Specific measures for prevention of pathology it is not developed. Nonspecific preventive measures are based on observance of safety regulations on production, timely treatment of diseases of ENT organs, elimination of the centers of an infection which are localized in a facial skull. The differentiated approach in therapy of a neuralgic and giperpatichesky form allows to compensate the main clinical displays of pathology.