SPHENOPALATINE BLOCKS, RFA & NEUROLYSIS

Indications

Diagnose the cause of pain in the face and head

Manage the pain of certain types of chronic headaches

Manage sympathetically maintained facial pain

Procedure

The sphenopalatine ganglion (SPG) is a collection of nerves (sympathetic, parasympathetic and some sensory). It lies in a body cavity called the pterygopalatine fossa, which is deep in the midface.

It supplies the lachrymal gland, paranasal sinuses, glands of the mucosa of the nasal cavity and pharynx, the gingival, and the mucous membrane and glands of the hard palate. It is not involved in feeling or movement.

Sometimes after a nerve is sensitized by trauma, infection or other causes, the sympathetic activity can cause pain. Blocking the sympathetic activity by anesthetizing the SPG may stop the pain. During a sphenopalatine ganglion block, pain-relieving medicine is injected to the region where the ganglion lies under fluoroscopic guidance. This may reduce the release of the chemical norepinepherine activating the pain sensitive nerves and reduce the pain.

The patient is usually sedated, and using X-ray (fluoroscopy) guidance, a fine needle is placed near the SPG and anesthetic is injected. The patient will not feel numbness in the face. Pain relief may also not be immediate. If pain relief is good with local anesthetic but for a few days or weeks we do a radiofrequency ablation of SPG or neurolysis for long lasting pain relief.