Joe asked his primary care provider why he had fits of sneezing, often mounting into double digits. There was no warning, he had no allergies, and they were not associated with any cold symptoms or other conditions. This condition had been present for as long as Joe could remember. He sought care because after a recent dental procedure that required anesthetizing of the mandibular branch of CN V, he did not sneeze for several days. 

It is generally accepted that the “sneeze center” is in the medullary area of the brainstem, and specifically associated with the fifth cranial nerve, the trigeminal. With the three branches of this, the largest of the cranial nerves, the majority of facial sensory messages are sent and received. Experimentally, researchers have noted that the association of irritation of the trigeminal nerve root (at approximately C 1-2-3) gives rise to sneezing. After extensive examination and history, it was found that Joe had significant cervical spine impingement of these levels due to notable scoliosis. Since the sneezing fits did not represent a serious condition, Joe was reassured that his condition was benign.

Continue Reading

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.