Combined sphenopalatine ganglion and mandibular nerve, neurolytic block for pain due to advanced head and neck cancer

Varghese, Bipin T.; Koshy, Rachel Cherian; Sebastián, Paúl; Joseph, Elsamma

doi:10.1191/0269216302pm549xx

Cited by 18 publications

(5 citation statements)

References 3 publications

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“…To date, there are few case reports supporting this theory 12,13 . One case study described the successful combination of sphenopalatine and trigeminal neurolytic block for face pain because of a tumor causing a large mid facial defect 13 . Sphenopalatine blocks have had success in treating cluster headaches, which typically occur in the peri‐orbital region similar to that described by the patient 14 .…”

Section: Discussionmentioning

confidence: 93%

“…As early as 1925, Ruskin speculated that sphenopalatine ganglion was involved in the pathogenesis of TN and that a sphenopalatine block could relieve TN 11 . To date, there are few case reports supporting this theory 12,13 . One case study described the successful combination of sphenopalatine and trigeminal neurolytic block for face pain because of a tumor causing a large mid facial defect 13 .…”

Section: Discussionmentioning

confidence: 99%

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Pulsed Radiofrequency V2 Treatment and Intranasal Sphenopalatine Ganglion Block: A Combination Therapy for Atypical Trigeminal Neuralgia

Nguyen

Wilkes

2010

Pain Practice

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Trigeminal neuralgia (TN) is a chronic condition affecting the fifth cranial nerve and resulting in sporadic intense burning and shock-like pain lasting for seconds to minutes that can be incapacitating to patients. Atypical TN includes additional features such as continuous pain and sensory disturbances in the area innervated by one or more branches of the trigeminal nerve. Documented cases of TN have dated back to the 18th century. Today, there are roughly 140,000 people suffering with this condition in the U.S.A. Conventional treatments for this disorder include medical management with nonconvulsants such as carbamazepine, which decrease the nerves response to peripheral stimulation. These agents have good initial pain relief, but relief rates fall off dramatically over the long-term. Recently, methadone has shown promise as a pharmacologic adjunct to patients with intractable neuropathic noncancer pain, including patients suffering from TN. Cases refractory to medical management can be treated with surgical microdecompression or minimally invasive procedures such as radiofrequency (RF) treatment. Pulsed RF (PRF) is a method gaining interest as it is delivered in pulses, allowing adequate time for dissipation of heat and energy resulting in less damage to surrounding structures. This case report describes the successful treatment of atypical V2 TN refractive to medical management requiring PRF treatment, a sphenopalatine block series, and low-dose methadone.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Pulsed Radiofrequency V2 Treatment and Intranasal Sphenopalatine Ganglion Block: A Combination Therapy for Atypical Trigeminal Neuralgia

Nguyen

Wilkes

2010

Pain Practice

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“…17,18 Combination of sphenopalatine and trigeminal neurolytic block was reported to be successful in a case study to relieve facial pain due to a tumor that caused a large mid-facial defect. 19 Sphenopalatine blocks have been successfully used to treat cluster headaches that typically occur in the periorbital region as described by the patient. 20 PRF of the SPG is effective in treating the patients suffering from intractable chronic facial and head pain as shown by our findings.…”

Section: Discussionmentioning

confidence: 99%

Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain

Akbaş

Gündüz

Sanlı

et al. 2016

Brazilian Journal of Anesthesiology (English Edition)

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“…It may be appropriate to add central or trigeminal autonomic dysregulation to the working diagnoses along with migraine and other painful head and facial disorders. There is also an application for this intervention with patients suffering from the pain associated with head and face cancers (4), and the use of this device can assure more precise delivery of analgesic substances in patients with advanced cancers.…”

Section: E775mentioning

confidence: 99%

A Novel Revision to the Classical Transnasal Topical Sphenopalatine Ganglion Block for the Treatment of Headache and Facial Pain

Candido

2013

Pain Phys

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Background: The sphenopalatine ganglion (SPG) is located with some degree of variability near the tail or posterior aspect of the middle nasal turbinate. The SPG has been implicated as a strategic target in the treatment of various headache and facial pain conditions, some of which are featured in this manuscript. Interventions for blocking the SPG range from minimally to highly invasive procedures often associated with great cost and unfavorable risk profiles. Objective: The purpose of this pilot study was to present a novel, FDA-cleared medication delivery device, the Tx360® nasal applicator, incorporating a transnasal needleless topical approach for SPG blocks. This study features the technical aspects of this new device and presents some limited clinical experience observed in a small series of head and face pain cases. Study Design: Case series. Settings: Pain management center, part of teaching-community hospital, major metropolitan city, United States. Methods: After Institutional Review Board (IRB) approval, the technical aspects of this technique were examined on 3 patients presenting with various head and face pain conditions including trigeminal neuralgia (TN), chronic migraine headache (CM), and post-herpetic neuralgia (PHN). The subsequent response to treatment and quality of life was quantified using the following tools: the 11-point Numeric Rating Scale (NRS), Modified Brief Pain Inventory — short form (MBPI-sf), Patient Global Impression of Change (PGIC), and patient satisfaction surveys. The Tx360® nasal applicator was used to deliver 0.5 mL of ropivacaine 0.5% and 2 mg of dexamethasone for SPG block. Post-procedural assessments were repeated at 15 and 30 minutes, and on days one, 7, 14, and 21 with a final assessment at 28 days post-treatment. All patients were followed for one year. Individual patients received up to 10 SPG blocks, as clinically indicated, after the initial 28 days. Results: Three women, ages 43, 18, and 15, presented with a variety of headache and face pain disorders including TN, CM, and PHN. All patients reported significant pain relief within the first 15 minutes post-treatment. A high degree of pain relief was sustained throughout the 28 day follow-up period for 2 of the 3 study participants. All 3 patients reported a high degree of satisfaction with this procedure. One patient developed minimal bleeding from the nose immediately post-treatment which resolved spontaneously in less than 5 minutes. Longer term follow-up (up to one year) demonstrated that additional SPG blocks over time provided a higher degree and longer lasting pain relief. Limitations: Controlled double blind studies with a higher number of patients are needed to prove efficacy of this minimally invasive technique for SPG block. Conclusion: SPG block with the Tx360® is a rapid, safe, easy, and reliable technique to accurately deliver topical transnasal analgesics to the area of mucosa associated with the SPG. This intervention can be delivered in as little as 10 seconds with the novice provider developing proficiency very quickly. Further investigation is certainly warranted related to technique efficacy, especially studies comparing efficacy of Tx360 and standard cotton swab techniques. Key words: Trigeminal neuralgia, trigeminal neuropathy, migraine, headache, post-herpetic neuralgia, sphenopalatine ganglion block

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Combined sphenopalatine ganglion and mandibular nerve, neurolytic block for pain due to advanced head and neck cancer

Cited by 18 publications

References 3 publications

Pulsed Radiofrequency V2 Treatment and Intranasal Sphenopalatine Ganglion Block: A Combination Therapy for Atypical Trigeminal Neuralgia

Pulsed Radiofrequency V2 Treatment and Intranasal Sphenopalatine Ganglion Block: A Combination Therapy for Atypical Trigeminal Neuralgia

Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain

A Novel Revision to the Classical Transnasal Topical Sphenopalatine Ganglion Block for the Treatment of Headache and Facial Pain

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