Sphenopalatine Ganglion Block via the Transnasal Approach




Indications and Clinical Considerations


Sphenopalatine ganglion block may be used in the treatment of acute migraine headache, acute cluster headache, and a variety of facial neuralgias including Sluder, Vail, and Gardner syndromes ( Figure 17-1 ). This technique is also useful in the treatment of status migrainosus and chronic cluster headache. There is anecdotal evidence that sphenopalatine ganglion block may also be useful in the palliation of pain secondary to acute herpes zoster of the trigeminal nerve.




FIGURE 17-1


Acute right-sided cluster headache. Note the ipsilateral ptosis and miosis. Additionally there is obvious ipsilateral lacrimation and rhinorrhea (see upper lip).

(From Benoliel R, Sharav Y: The trigeminal autonomic cephalgias [TACs]. In Sharav Y, Benoliel R, editors: Orofacial pain and headache , Edinburgh, 2008, Mosby, pp 225ā€“254; Fig. 10-1.)


Neurodestructive procedures of the sphenopalatine ganglion with neurolytic agents, radiofrequency lesions, and freezing may be indicated for the palliation of cancer pain and rarely for headache and facial pain syndromes that fail to respond to conservative management. Recent experience with electrical stimulation of the sphenopalatine ganglion has shown promising early results.




Clinically Relevant Anatomy


The sphenopalatine ganglion (pterygopalatine, nasal, or Meckel ganglion) is located in the pterygopalatine fossa, posterior to the middle nasal turbinate ( Figure 17-2 ). It is covered by a 1- to 1.5-mm layer of connective tissue and mucous membrane. This 5-mm triangular structure sends major branches to the gasserian ganglion, trigeminal nerves, carotid plexus, facial nerve, and superior cervical ganglion (see Figures 17-2 and 17-3 ). The sphenopalatine ganglion can be blocked by topical application of local anesthetic or by injection.




FIGURE 17-2


The anatomy of the sphenopalatine (pterygopalatine) ganglion. Note that the sphenopalatine (pterygopalatine) structure sends major branches to the gasserian ganglion, trigeminal nerves, carotid plexus, facial nerve, and superior cervical ganglion.

(From Barral J-P, Croibier A: Maxillary nerve. In Manual therapy for the cranial nerves , Edinburgh, 2009, Churchill Livingstone, pp 129ā€“138; Fig. 16-3, p 131.)

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Feb 1, 2019 | Posted by in PAIN MEDICINE | Comments Off on Sphenopalatine Ganglion Block via the Transnasal Approach
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