FAG’s on Sphenopalatine Ganglion Block in Philadelphia

A sphenopalatine ganglion block is a procedure used to treat facial and head pain. This minimally invasive procedure is performed in the office setting, and requires technical proficiency from trained physicians.

What conditions are treated with the sphenopalatine ganglion block?

This block is an established treatment for many pain syndromes. These include:

  • Sphenopalatine neuralgia
  • Trigeminal neuralgia
  • Cluster headaches
  • Migraine headaches
  • Cancer pain of the neck and/or head
  • Atypical face pain
  • Sluder’s neuralgia
  • Temporomandibular joint (TMJ) syndrome
  • Tongue and/or mouth pain
  • Paroxysmal hemicrania
  • Vasomotor rhinitis
  • Complex regional pain syndrome (CRPS)
  • Herpes zoster (shingles)
  • Post-herpetic neuralgia
  • Cluster headache

What nerves are targeted with the sphenopalatine ganglion block?

Also called the Meckel’s ganglion and pterygopalatine ganglion, the sphenopalatine ganglion is a bundle of parasympathetic nerves that derive from the maxillary nerve (a portion of the trigeminal nerve). These nerves are located in the pterygopalatine fossia, which borders the palatine bone, maxillary sinus, and sphenoid sinus. These nerves provide sensation to the soft palate, nasal membranes, upper teeth, roof of mouth, sinuses, lacrimal glands, pharynx (throat), and mid-face region.

How do I prepare for the sphenopalatine ganglion block?

You should not eat or drink after midnight before the procedure, but should take regular medications with small sips of water. Be sure to notify the doctor of any blood-thinning agents you are taking, and bring someone to drive you home. When you arrive at the medical center, a nurse will go over the procedure and ask you to sign a form for consent. Once you change into a gown, the nurse places an IV catheter in your arm to administer fluids, medications, and a sedative, if required. Monitoring devices are used to assess oxygen level, blood pressure, and heart rate.

How is the procedure performed?

There are three approaches used to perform the sphenopalatine ganglion block: intranasal (through the nose), transoral (through the mouth), and infrazygomatic (through the cheek). The most common approach is the intranasal. The doctor will position you on your back with your head slightly tilted backward. A small amount of numbing solution is introduced through one nostril, which numbs the back of the throat when you quickly inhale. Once the nasal passage is anesthetized, the doctor inserts a flexible catheter to instill an anesthetic and/or neurolytic agent. When good response to the block is achieved, the doctor may consider offering radiofrequency ablation to destroy a portion of the nerves, which offers long-term pain relief.

What happens after the sphenopalatine ganglion block?

A nurse will monitor your vital signs and condition for 20-30 minutes after the procedure. You should have someone drive you home and rest for the remainder of the day.

What are the benefits of the sphenopalatine ganglion block?

The sphenopalatine ganglion block is an effective, safe procedure. It can be used to treat a variety of conditions, and is done in the outpatient setting. The side effects to the medications are few, and complications rarely occur.

What risks are associated with the sphenopalatine ganglion block?

As with any medical procedure, there are a few complications to consider with this block. Risks include infection, bleeding, nerve damage, and blood vessel injury. The most common side effect is a bitter taste in the mouth from the local anesthetic agent dripping down the back of the throat. Lightheadedness is common, but this usually resolves within 20-30 minutes.

Does the sphenopalatine ganglion block work?

In a recent study where the block was used to treat chronic head and face pain, patients enjoyed an 86% success rate with the procedure. In large review of studies, researchers recommended the sphenopalatine ganglion block for the treatment of cluster headache, tooth pain, trigeminal neuralgia, and head/neck cancer pain.

Resources

Bayer E., Racz G., Day M., et al: Sphenopalatine ganglion pulsed radiogrequency treatment in 30 patients suffering from chronic face and head pain. Pain Practice. 2005; 5:223.

Manahan AP, Malesker MA, Malone PM. Sphenopalatine ganglion block relieves symptoms of trigeminal neuralgia: a case report. Nebr Med J. 1996; 81:306-9

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.

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; 61:319-21.

Quevedo J, Purgavie K, Platt H, et al.: Complex regional pain syndrome involving the lower extremity. a report on 2 cases of sphenopalatine ganglion block as a treatment option Arch Phys Med Rehabil. 2005; 86:335-337.