The distal branches of the glossopharyngeal nerve are located submucosally immediately posterior to the palatine tonsil, deep to the posterior tonsillar pillar.
Glossopharyngeal blocks can be achieved from an intraoral approach or externally next to the styloid process.
Bending the tip of the needle helps positioning the needle submucosally in posttonsillar be when performing the intraoral approach.
Glossopharyngeal block is useful for anesthesia of the mucosa of the pharynx and soft palate, as well as for eliminating the gag reflex that results when pressure is applied to the posterior third of the tongue.
Patient Selection. Glossopharyngeal block can be used in most patients who need atraumatic, sedated, spontaneously ventilating, “awake” tracheal intubation.
Pharmacologic Choice. The local anesthetic chosen for glossopharyngeal block does not need to provide motor blockade. Lidocaine (0.5%) is an appropriate choice of local anesthetic.
Anatomy. The glossopharyngeal nerve exits from the jugular foramen at the base of the skull, as illustrated in Fig. 26.1 , in close association with other structures of the carotid sheath, vagus nerve, and styloid process. The glossopharyngeal nerve descends in the neck, passes between the internal carotid and the external carotid arteries, and then divides into pharyngeal branches and motor branches to the stylopharyngeus muscle, as well as branches innervating the area of the palatine tonsil and the posterior third of the tongue. These distal branches of the glossopharyngeal nerve are located submucosally immediately posterior to the palatine tonsil, deep to the posterior tonsillar pillar.