Sphenopalatine Ganglion Block via the Transnasal Approach

Indications and Clinical Considerations

Sphenopalatine ganglion block may be used in the treatment of acute migraine headache, acute cluster headache, and a variety of facial neuralgias including Sluder, Vail, and Gardner syndromes ( Figure 17-1 ). This technique is also useful in the treatment of status migrainosus and chronic cluster headache. There is anecdotal evidence that sphenopalatine ganglion block may also be useful in the palliation of pain secondary to acute herpes zoster of the trigeminal nerve.

Neurodestructive procedures of the sphenopalatine ganglion with neurolytic agents, radiofrequency lesions, and freezing may be indicated for the palliation of cancer pain and rarely for headache and facial pain syndromes that fail to respond to conservative management. Recent experience with electrical stimulation of the sphenopalatine ganglion has shown promising early results.

Clinically Relevant Anatomy

The sphenopalatine ganglion (pterygopalatine, nasal, or Meckel ganglion) is located in the pterygopalatine fossa, posterior to the middle nasal turbinate ( Figure 17-2 ). It is covered by a 1- to 1.5-mm layer of connective tissue and mucous membrane. This 5-mm triangular structure sends major branches to the gasserian ganglion, trigeminal nerves, carotid plexus, facial nerve, and superior cervical ganglion (see Figures 17-2 and 17-3 ). The sphenopalatine ganglion can be blocked by topical application of local anesthetic or by injection.