Assistant Professor University of Wisconsin Madison, Wisconsin, United States
Case Diagnosis: Atypical facial pain
Case Description: A 46-year-old female presented with pain over the right side of her nares. She underwent a right central incisor extraction with subsequent implant 2 years prior. The pain began after the implant and was associated with a rash and rhinorrhea. She was evaluated by dermatology and was treated for shingles without relief. She was then treated for impetigo. The rash subsided, but the pain remained. She described the pain as sharp on the inside tip of her right nares but can fluctuate to dull and achy. A sphenopalatine ganglion block was performed with an intranasal topical approach. A cotton tip applicator soaked in 2% viscous lidocaine was inserted into the right nasal cavity until resistance was met at the posterior wall of the nasopharynx and remained in place for 10 minutes. On follow up one month later, the patient reported that her pain resolved a few days after the procedure.
Discussions: The sphenopalatine ganglion is the largest and most superior ganglion of sensory, sympathetic, and parasympathetic nerves. Sphenopalatine ganglion blocks have been used to treat a variety of pain syndromes, and the procedure can be done through an intranasal topical, intranasal injection, transoral injection, or infrazygomatic injection approach. The strongest evidence for using this procedure is for cluster headaches, however, there are reports for using this procedure for other types of pain. Patients who have short term pain relief after a block may benefit from radiofrequency ablation or neurostimulation of the ganglion. This patient had pain relief for over 3 weeks after the procedure and may benefit from these procedures.
Conclusions: Sphenopalatine ganglion blocks may be used to treat atypical presentations of facial pain. Further controlled trials would be beneficial to further assess the benefit of the procedure.
