Clinical Anatomy of Blockade of the Pterygopalatine Ganglion: Literature Review and Pictorial Tour Using Cadaveric Images

Iwanaga, Joe; Wilson, Charlotte; Simonds, Emily; Vetter, Marc; Schmidt, Cameron; Yılmaz, Emre; Choi, Paul J; Oskouian, Rod J.; Tubbs, R. Shane

doi:10.2739/kurumemedj.ms651001

Cited by 11 publications

(4 citation statements)

References 26 publications

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“…SPG blocking has been described for more than 100 years for the control of headaches and pain in oncology. [32] The physiological mechanism might be based on parasympathetic modulation that leads to a reversal of cerebral arterial vasodilation. [33] In contrast, the blockade of the sympathetic neurons of the SPG can control blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report

2022

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Background: Post COVID-19 syndrome (PC-19S) appears to be independent of acute illness severity and humoral response. The involvement of the autonomic nervous system (ANS), expressed by dysautonomia, has been hypothesized as a contributor. Several studies have associated the therapeutic effects of local anesthetics (LA) to their action on the ANS. To the best of our knowledge, this is the first report of therapeutic injections with LA linked to clinical improvement in a patient with PC-19S. Patient concerns and diagnoses: This was a 54-year-old-man with postCOVID-19 symptoms lasting 14 weeks, including fatigue, breathlessness, diarrhea, muscle pain, and emotional lability. Interventions and outcome: Injections of 0.5% procaine in the stellate ganglion (SG) and sphenopalatine ganglion (SPG), and in clinically relevant points in the scalp, thorax, and abdomen were performed 3 times over 3 months. The patient reported progressive improvement and was asymptomatic upon completing the treatment. Prescribed medications were discontinued. The 36-Item Short Form Health Survey (SF-36) score showed significant improvement across all SF-36-domains. Conclusion: Subanesthetic doses of LA injected in clinically relevant points led to rapid and complete symptom resolution in this patient with PC-19S. Targeted LA injections may have therapeutic benefits in PC-19S and in other chronic diseases linked to stress and inflammation.

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Section: Discussionmentioning

confidence: 99%

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report

2022

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“…When comparing treatments, it is also noteworthy that the actual anatomy and possible diffusion to the SPG have been questioned, making the observed effect potentially entirely mechanical. 24,25 The findings that the two groups had similar response to the SPG stimulus and that the prolonged effect of the block does not correspond to the pharmacodynamic properties of the local anaesthetics could support this hypothesis. As such, another limitation is the lack of a pure control group, and further studies using either a sham block application or measurements of the actual effect on the cerebral vascular tone may be required to explore the physiological effects of the local anaesthetic in the SPG block.…”

Section: Measurementmentioning

confidence: 98%

Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial

Jespersen

Jæger

Ægidius

et al. 2020

British Journal of Anaesthesia

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Background: Current treatment of postdural puncture headache includes epidural blood patch (EBP), which is invasive and may result in rare but severe complications. Sphenopalatine ganglion block is suggested as a simple, minimally invasive treatment for postdural puncture headache. We aimed to investigate the analgesic effect of a transnasal sphenopalatine ganglion block with local anaesthetic vs saline. Methods: We conducted a blinded, randomised clinical trial including adults fulfilling the criteria for EBP. Participants received a sphenopalatine ganglion block bilaterally with 1 ml of either local anaesthetic (lidocaine 4% and ropivacaine 0.5%) or placebo (saline). Primary outcome was pain in upright position 30 min post-block, measured on a 0e100 mm VAS. Results: We randomised 40 patients with an upright median pain intensity of 74 and 84 mm in the local anaesthetic and placebo groups at baseline, respectively. At 30 min after sphenopalatine ganglion block, the median pain intensity in upright position was 26 mm in the local anaesthetic group vs 37 mm in the placebo group (estimated median difference: 5 mm; 95% confidence interval: e14 to 21; P¼0.53). In the local anaesthetic group, 50% required an EBP compared with 45% in the placebo group (P¼0.76). Conclusions: Administration of a sphenopalatine ganglion block with local anaesthetic had no statistically significant effect on pain intensity after 30 min compared with placebo. However, pain was reduced and EBP was avoided in half the patients of both groups, which suggests a major effect not necessarily attributable to local anaesthetics. Clinical trial registration: NCT03652714.

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“…In cats, stimulation of the cervical sympathetic trunk decreases both nasal airway resistance and sphenopalatine venous outflow [10,11]. On the other hand, stimulation of the vidian nerve (pterygopalatine ganglion) [12] can increase both nasal airway resistance and sphenopalatine venous outflow [11,13]. In dogs, it is known that blood from the nasal mucosa drains via two main pathways i.e., the anterior two thirds via the external (dorsal) nasal vein and posterior one third via the SPV [14].…”

Section: Nasal Congestion In Rhinitismentioning

confidence: 99%

The sphenopalatine vein: anatomical study of a rarely described structure

Iwanaga

Pineda

Miyamoto³

et al. 2023

Anat Cell Biol

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Although in counterpart, the sphenopalatine artery (SPA), has been well described in the medical literature, the sphenopalatine vein (SPV) has received scant attention. Therefore, the present anatomical study was performed. Additionally, we discuss the variations, embryology, and clinical significance of the SPV. Adult cadaveric specimens underwent dissection of the SPV. In addition, some specimens were submitted for histological analysis of this structure. The SPV was found to drain from the sphenoidal sinus and nasal septum. Small tributaries traveled through the nasal septum with the posterior septal branches of the SPA and nasopalatine nerve. The SPA and SPV were found to travel through the sphenopalatine foramen and another tributary was found to perforate the medial plate of the pterygoid process and to connect to the pterygoid venous plexus which traveled lateral to the medial plate of the pterygoid process. The vein traveled through the posterior part of the lateral wall of the nasal cavity with the posterior lateral nasal branches of the SPA and the lateral superior posterior nasal branches of the maxillary nerve. To our knowledge, this is the first anatomical study on the SPV in humans. Data on the SPV provides an improved anatomical understanding of the vascular network of the nasal cavity. Developing a more complete picture of the nasal cavity and its venous supply might help surgeons and clinicians better manage clinical entities such as posterior epistaxis, cavernous sinus infections, and perform endoscopic surgery with fewer complications.

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Clinical Anatomy of Blockade of the Pterygopalatine Ganglion: Literature Review and Pictorial Tour Using Cadaveric Images

Cited by 11 publications

References 26 publications

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report

Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial

The sphenopalatine vein: anatomical study of a rarely described structure

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