SPHENOPALATINE GANGLION BLOCK

Sphenopalatine-Ganglion Pain, especially in the face and head, is a condition that may be secondary to these conditions.

• Acute and cluster headaches
• Trigeminal neuralgia. (3,7)
• Temporomandibular joint (TMJ) pain.(7)
• Herpes zoster. (12)
• Sluder’s neuralgia. (6)
• Paroxysmal hemicrania. (4)
• Atypical facial pain. (14)
• Head and neck cancers
• Complex regional pain syndrome (CRPS) (9)
• Reflex Sympathetic Dystrophy (RSD) (9)
• Vasomotor rhinitis
• Pre- and postoperative anesthesia in oral and maxillofacial surgery. (11)

Benefit:

Sphenopalatine Ganglion Block is a short, minimally invasive procedure that is effective at treating some acute and chronic facial and head pain.

Anatomy:

The Sphenopalatine Ganglion is a collection of nerves that is close to the surface. It is located in the depression of the skull behind the middle nasal bone, and in front of the nasal canal. The Sphenopalatine Ganglion is covered by a layer of connective tissue and mucous membrane which allows its block to be applied either topically or by injection (17,18,19).

Procedure:

There are many approaches your physician can use to perform the Sphenopalatine Ganglion Block, including the transnasal, transoral, and lateral approach. The transnasal approach is the simplest and most common technique among the three. You will be asked to lie down on your back and extend your neck into a sniffing position. Your physician will inspect your anterior nares (inside your nostrils) for any visible polyps, tumors, or significant septal deviation before beginning. A small amount of 2% viscous lidocaine is instilled into the nostrils being treated, after which you will be asked to briskly inhale. This draws the local anesthetic toward the back of your nose, lubricating it and anesthetizing it in the process, while making the procedure more comfortable for the patient. If your physician decides to perform the Sphenopalatine Ganglion Block topically, he or she will introduce a sterile 10-cm cotton tipped applicator dipped in anesthetic and slowly insert it in your nose. The applicator is usually left in place for approximately 20-30 minutes. If your physician decides to perform the Sphenopalatine Ganglion Block via injection, your physician will anesthetize part of your cheek. Next he or she will advance a small needle under X-Ray guidance through the anesthetized tissue. Your physician will carefully advance the needle to the correct location, after which he or she will confirm correct positioning under fluoroscopy before injecting the anesthetic. No matter whether placed topically or via injection, a successful block is marked by profound pain relief. For patients who have a documented response to administration of local anesthetic onto the Sphenopalatine Ganglion, you and your physician may decide upon performing a neurolysis or radioablation of the sphenopalatine ganglion for longer duration of pain and symptom relief. Depending on whether your physician performs this block topically or via injection, this procedure may take anywhere from 15 minutes to 30 minutes at most. Sometimes your physician will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor your pain and vital signs (pulse, blood pressure) after the procedure.

Risk:

The risk for this procedure is very low. The most common side effects of this procedure include developing a bitter taste in your mouth from the local anesthetic potentially dripping down from the nasopharynx. You may develop a slight numbness in the back of the throat from the local anesthetic dripping down into your throat. You may develop a nose bleed from your physician accidentally abrading your internal nare from the placing of the block. Some patients may also experience slight lightheadedness that usually resolves after 20-30 minutes after the procedure. With any procedure that involves local anesthetic there is a slight risk of drug allergy and seizure. Lastly, as with any penetration of skin and soft tissues, the risk of infection always exists.

Outcomes:

Sphenopalatine Block is a well-established treatment for acute and chronic facial and head pain. Having a Sphenopalantine Radiofrequency Ablation is a proven and effective treatment for patients with chronic cluster headaches.

References:

• Ferrante FM, Kaufman AG, Dunbar SA, Cain CF, Cherukuri S. Sphenopalatine ganglion block for the treatment of myofascial pain of the head, neck, and shoulders. Reg Anesth Pain Med. 1998 Jan-Feb;23(1):30-6.
• Janzen VD, Scudds R. Sphenopalatine blocks in the treatment of pain in fibromyalgia and myofascial pain syndrome. Laryngoscope. 1997 Oct;107(10):1420-2.
• Manahan AP, Malesker MA, Malone PM. Sphenopalatine ganglion block relieves symptoms of trigeminal neuralgia: a case report. Nebr Med J. 1996 Sep;81(9):306-9.
• Morelli N, Mancuso M, Felisati G, Lozza P, Maccari A, Cafforio G, Gori S, Murri L, Guidetti D. Does sphenopalatine endoscopic ganglion block have an effect in paroxysmal hemicrania? A case report. Cephalalgia. 2009 May 5.
• Narouze S, Kapural L, Casanova J, Mekhail N. Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache. Headache. 2009 Apr;49(4):571-7. Epub 2008 Sep 9.
• Olszewska-Ziaber A, Ziaber J, Rysz J. [Atypical facial pains–sluder’s neuralgia–local treatment of the sphenopalatine ganglion with phenol–case report] Otolaryngol Pol. 2007;61(3):319-21. [Article in Polish]
• Peterson JN, Schames J, Schames M, King E. Sphenopalatine ganglion block: a safe and easy method for the management of orofacial pain. Cranio. 1995 Jul;13(3):177-81.
• Prasanna A, Murthy PS. Vasomotor rhinitis and sphenopalatine ganglion block. J Pain Symptom Manage. 1997 Jun;13(6):332-8.
• Quevedo JP, Purgavie K, Platt H, Strax TE. Complex regional pain syndrome involving the lower extremity: a report of 2 cases of sphenopalatine block as a treatment option. Arch Phys Med Rehabil. 2005 Feb;86(2):335-7.
• Raj P, Lou L, Erdine S et al. Radiographic imaging for regional anesthesia and pain management. New York, Churchill Living-stone, 2003, pp 66-71.
• Robiony M, Demitri V, Costa F, Politi M. [Percutaneous maxillary nerve block anesthesia in maxillofacial surgery] Minerva Stomatol. 1999 Jan-Feb;48(1-2):9-14. Italian.
• Saberski L, Ahmad M, Wiske P. Sphenopalatine ganglion block for treatment of sinus arrest in postherpetic neuralgia. Headache. 1999 Jan;39(1):42-4.
• Sanders M, Zuurmond WW. Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation. J Neurosurg. 1997 Dec;87(6):876-80.
• Stechison MT, Brogan M. Transfacial transpterygomaxillary access to foramen rotundum, sphenopalatine ganglion, and the maxillary nerve in the management of atypical facial pain. Skull Base Surg. 1994;4(1):15-20.
• Varghese BT, Koshy RC. Endoscopic transnasal neurolytic sphenopalatine ganglion block for head and neck cancer pain. J Laryngol Otol. 2001 May;115(5):385-7.
• Waldman S. Atlas of Interventional Pain Management. Philadelphia, WB Sanders, 1998, pp 10-12.
• Waldman, S. Sphenopalatine ganglion block- 80 years later. Reg Anesth 1993; 18:274-276.
• Waxman, S. Correlative Neuroanatomy, 23rd ed. Stamford, Appleton & Lange, 1996. Pp 265-266.
• Windsor RE, Jahnke S. Sphenopalatine ganglion blockade: a review and proposed modification of the transnasal technique. Pain Physician. 2004 Apr;7(2):283-6.
• Windsor R, Gore H, Merson M: Interventional sympathetic blockade. In Lennard T (ed.) Pain Procedures in Clinical Practice, 2nd ed. Philadelphia, Hanley & Belfus, 2000, pp 321-324.
• Yang Y, Oraee S. A novel approach to transnasal sphenopalatine ganglion injection. Pain Physician. 2006 Apr;9(2):13