Sphenopalatine Ganglion Block

facial pain2The sphenopalatine ganglion (SPG) block is an injection of an anesthetic through one or both nostrils or the check with a needle-like device. The anesthetic numbs the ganglion area to provide pain relief for discomfort associated with facial pain and multiple headache conditions.

What is the sphenopalatine ganglion?

The sphenopalatine ganglion is a mass of nerves that reach out to the paranasal sinuses, lacrimal gland, palate, upper pharynx, and nasal cavity. The ganglion is located in a bony cavity called the pterygopalatine fossa, which is behind the nasal cavity, deep in the midface region.

This nerve bundle plays a role in pain associated with cluster and acute headaches, trigeminal neuralgia, reflex sympathetic dystrophy (RSD), herpes zoster (shingles), head and neck cancer pain, and more.

What conditions are treated with the sphenopalatine ganglion block?

This outpatient procedure is well-tolerated by most patients. The block can help relief the pain associated with:

  • Acute and cluster headaches
  • TMJ syndrome
  • Shingles pain
  • Cancer pain
  • Vasomotor rhinitis
  • Sluder’s neuralgia
  • Atypical facial pain
  • Trigeminal neuralgia

How is the procedure performed?

The three most common methods to perform the SPG block are the transnasal (through the nostril), transoral (through the mouth), and lateral (through the cheek). The transnasal approach is the simplest and most common technique used.Sphenopalatine_Ganglion_Block

With a sterile, cotton-tipped applicator, the doctor will apply a gel anesthetic into the nostril to numb the region. The needle is inserted using x-ray guidance. Once in position, an anesthetic is inserted into the nerve bundle.

Will the procedure hurt?

Because there is a numbing gel applied, the procedure is relatively painless. You will feel a pressure sensation as the needle device is inserted thought the nostril, however. The device is soft and flexible, so there is minimal tissue irritation associated with the SPG block.

How long does the procedure take?

The total time for numbing the region, inserting the medication, and recovery time is around 30 to 45 minutes. It takes around 10 to 15 minutes for the anesthetic gel to begin working, but the actual injection only takes a couple of minutes. You will be kept in the lying position for approximately 10 to 15 minutes following the injection.

Does the SPG block work?

According to research studies, the sphenopalatine ganglion block is a proven effective procedure. Approximately two-thirds of patients who have an SPG block report improved symptoms within 7 days of the procedure. Additionally, about half of treated patients report symptom relief within a month of the procedure.

What are the risks and complications of the SPG block?

There are a few risks and complications associated with the SPG block, but the occurrence of these issues is rare. Some patients report a bitter taste in the mouth, which is related to the anesthetic dripping into the mouth. Temporary lightheadedness can occur, and there is a slight risk for nosebleed.

Resources

Felisati G, Arnone F, Lozza P, et al. Sphenopalatine endoscopic ganglion block: A revision of a traditional technique for cluster headache. Laryngoscope. 2006;116:1447–1450.