Answer to Saving Private Ryan

Correct answer is E. Post-ganglionic fibers from the pterygopalatine ganglion neurons innervate the lacrimal glands, the blood vessels of the eye, the blood vessels and secretory glands of the nasal cavity and palate, and the cerebral blood vessels. The symptoms described in the Billionaire of absence of tearing and vasomotor rhinitis  can be explained by damage to this ganglion. Yes, this would be a rare event, but the BB is small enough that in theory the head could have been tilted in such a way that the BB entered the infratemporal fossa, lodged itself in the upper portion of the pterygopalatine fossa, at the sphenopalatine foramen, and injured the pterygopalatine ganglion. Skin and muscle damage was negligible enough that the Billionaire could try to live through the discomfort. The headache is also consistent with a lesion to the pterygopalatine ganglion. The ganglion is theorized to be a component for a group of headache disorders classified as trigeminal autonomic cephalalgias (TACs) which present as unilateral headaches with ipsilateral autonomic features (lacrimation, rhinorrhea, nasal congestion, eyelid edema, and ptosis).

Answer to this question is based on material presented in lectures 2 and 8 of the Head and Neck Lecture Series.

1 = Supraorbital n.

2 = Lingual n.

3 = Chorda tympani

4 = Facial n.

5 = Pterygopalatine ganglia