The Pterygopalatine Ganglion and its Role in Various Pain Syndromes: From Anatomy to Clinical Practice

Abstract

The postsynaptic fibers of the pterygopalatine or sphenopalatine ganglion (PPG or SPG) supply the lacrimal and nasal glands. The PPG appears to play an important role in various pain syndromes including headaches, trigeminal and sphenopalatine neuralgia, atypical facial pain, muscle pain, vasomotor rhinitis, eye disorders, and herpes infection. Clinical trials have shown that these pain disorders can be managed effectively with sphenopalatine ganglion blockade (SPGB). In addition, regional anesthesia of the distribution area of the SPG sensory fibers for nasal and dental surgery can be provided by SPGB via a transnasal, transoral, or lateral infratemporal approach. To arouse the interest of the modern-day clinicians in the use of the SPGB, the advantages, disadvantages, and modifications of the available methods for blockade are discussed.▪

Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy

“…One of the contributors to this vasodilatation is mediated by parasympathetic activity by the neurons which have synapses in the SPG. This is how an SPG block helps in alleviating a headache which is mediated by the neurons in the SPG [10]. …”

Noninvasive Sphenopalatine Ganglion Block for Acute Headache in the Emergency Department: A Randomized Placebo-Controlled Trial

“…[8][9][10][11][12] Sphenopalatine ganglion block has been described for treatment of facial and head pain, including cluster headaches, trigeminal neuralgia, and postoperative pain relief for ear, nose, and throat surgeries. [13][14][15][16][17] Recent evidence has implicated the sphenopalatine ganglion as an important neural relay point for common migraine. [8][9][10][11][12] Activation of the sphenopalatine ganglion causes parasympathetic-mediated vasodilation of the cerebral vasculature, producing cephalgia.…”

The Effect of Regional Anesthetic Sphenopalatine Ganglion Block on Self‐Reported Pain in Patients With Status Migrainosus

“…In the United States, visits to the emergency department (ED) for SM cost approximately $700 million per year. 4 Specifically, the SPG is located within the pterygopalatine fossa, behind the nasopharynx, posterior to the middle turbinate, and inferior to the sphenoid sinus ( Fig. In 2010, hospitalization cost for SM totaled approximately $375 million.…”