A novel approach to transnasal sphenopalatine ganglion injection.
BACKGROUND: Sphenopalatine ganglion block is used to treat headache and facial pain. There are transnasal, transoral and lateral approaches to establish the blockade. The transnasal application of topical anesthetic is the simplest and most common technique among the three. However, the diffusion of topical anesthetic to the ganglion is unpredictable and the blockade is not durable. OBJECTIVE: To describe a novel transnasal injection technique to block sphenopalatine ganglion. METHODS: The technique includes topical anesthesia to the nasal mucosa between the middle and inferior turbinates from nares to the nasopharynx, followed by a needle insertion in the same tract guided by its tailored plastic cover-sheath for blocking agent injection to the ganglion. RESULTS: Fluoroscopy revealed that with this technique the needle tip located near the medial pterygoid plate at the level of the middle concha and contrast flowed superoposteriorly to the maxilla without vascular uptake. Pain relief for this patient was prolonged from one day with topical technique to four weeks with this technique. The subsequent blocks without fluoroscopy provided similar prolonged pain relief. CONCLUSION: This method preserves the technical simplicity of the original transnasal approach and includes the predictability and durability of the blockade from needle injection.