Geng Zeyang, Wang Chenyang, Wang Ruilin, Zhang Aimin
Pain and Quality of Life Management Center SuperiorMed and Perennial Hospital Chengdu China.
Department of Pain Management Zhongnan Hospital of Wuhan University Wuhan China.
Clin Case Rep. 2024 Sep 19;12(9):e9436. doi: 10.1002/ccr3.9436. eCollection 2024 Sep.
Allergic rhinitis (AR) is a chronic noninfectious inflammation of the nasal mucosa mediated primarily by allergen-specific immunoglobulin E (IgE) in atopic individuals after exposure to allergens, with the involvement of non-IgE-mediated mechanisms and neuroimmune dysregulation. Conservative treatment of AR is ineffective in children who lack compliance, and traditional surgical procedures are risky, making treatment of this community challenging. The sphenopalatine ganglion (SPG), aka pterygopalatine ganglion, is the largest of the four parasympathetic ganglia located within the head region, existing as a bilateral pair. The fibers that arise from the SPG regulate secretomotor functions and provide sensation from various structures, including the lacrimal glands, the mucous membranes of the oropharynx, nasopharynx, nasal cavity, and upper portion of the oral cavity. Previous studies suggest that SPG plays a much crucial role in the neuro-related pathophysiological mechanisms of AR. Pulsed radiofrequency (PRF) is a commonly used technique in pain management to produce neuromodulatory effects without damaging nerve tissue. Previous research suggests that SPG dysfunction is one of the important pathophysiological mechanisms of trigeminal autonomic cephalalgia, and PRF targeting SPG can effectively exert neuromodulatory effects to improve its symptoms. We thus predicted that the application of PRF for neuromodulation of SPG would be beneficial for symptom remission in AR. We report the first case of AR successfully treated with PRF targeting the SPG, symptoms did ameliorate during the 24-week follow-up period, as manifested by the disappearance of nocturnal open-mouth breathing and its murmur and a significant reduction in the frequency and severity of daily episodes of nasal congestion, tearing, and conjunctival congestion, which diversifies clinical interventions for AR.
变应性鼻炎（AR）是一种慢性非感染性鼻黏膜炎症，主要由特应性个体在接触变应原后，通过变应原特异性免疫球蛋白E（IgE）介导，同时伴有非IgE介导机制和神经免疫失调的参与。AR的保守治疗对依从性差的儿童无效，传统手术存在风险，这使得该群体的治疗具有挑战性。蝶腭神经节（SPG），又称翼腭神经节，是位于头部区域的四个副交感神经节中最大的一个，呈双侧对称分布。来自SPG的纤维调节分泌运动功能，并为包括泪腺、口咽、鼻咽、鼻腔和口腔上部的黏膜等各种结构提供感觉。先前的研究表明，SPG在AR的神经相关病理生理机制中起着至关重要的作用。脉冲射频（PRF）是疼痛管理中常用的一种技术，可产生神经调节作用而不损伤神经组织。先前的研究表明，SPG功能障碍是三叉神经自主性头痛的重要病理生理机制之一，靶向SPG的PRF可有效发挥神经调节作用以改善其症状。因此，我们预测应用PRF对SPG进行神经调节将有利于AR症状的缓解。我们报告了首例通过靶向SPG的PRF成功治疗AR的病例，在24周的随访期内症状确实有所改善，表现为夜间张口呼吸及其杂音消失，以及每日鼻塞、流泪和结膜充血发作的频率和严重程度显著降低，这为AR的临床干预提供了更多样化的选择。
