A large group of patients have atypical facial neuralgia characterized by severe boring, at times burning, pain, not limited to the distribution of a cranial nerve but occurring back of the eye, over the zygoma, cheek or nose and occasionally over the mastoid region and down the neck. It cannot be brought on by touching or moving the area and is not lancinating as is trigeminal neuralgia. This syndrome is often temporarily relieved by cocainizing the sphenopalatine ganglion, and Sluder, who first described the condition, thought that permanent relief was sometimes obtained by the injection of alcohol into that ganglion. I have seen patients relieved after cocainization but not after injection of alcohol.Hypotheses as to the production of this pain are many. Davis and Pollock 1 stated the belief that they had disproved experimentally the existence of afferent sympathetic fibers. It was their opinion that stimulation of the efferent sympathetic fibers in turn stimulates the accepted pathways in the cranial nerves and produces the pain. Davis 2 expressed the belief that failure to relieve atypical neuralgia by section of the superior cervical ganglion and the sensory root of the fifth nerve shows that sensibility to pain on deep pressure is transmitted by the seventh nerve. Kuntz 3 stated the belief that there are no afferent fibers in the sympathetic nervous system. Because in some cases of atypical neuralgia there is a distribution of pain which corresponds not to the area of any sensory nerve but rather to areas of arterial supply, Fay 4 has advanced the possibility of another mechanism. He stated that sectioning of various combinations of nerves had led to the impression that the vascular pain fibers of the head and neck find entry to the cranial nerves through the vagus, for the most Read at the Forty
