Trigeminal Neuralgia Treated with Sphenopalatine Ganglion Block

I am an advocate of Self-Administered Sphenopalatine Ganglion Blocks for Trigeminal Neuralgia. Many patients have excellent results utilizing the self-administration protocols I teach but other are less successful.

Self-administration is the single most cost effective method and it allows patients to experience almost instant relief without visits to the ER or Physician offices. Lidocaine is a natural anti-inflammatory and almost all side effects are positive or only minimal nasal irritation.

The trans-nasal approach to sphenopalatine ganglion blocks has over 100 years of safety and efficacy since it was first reported in the Anals of Internal Medicine (JAMA) in 1908 by Sluder.

Patients who have moderate response to intranasal SPG Blocks will often respond better to either intra-oral injection of the ganglion or Suprazygomatic extra-oral injection.

Some patients can follow injection with self-administration where others see only limited long-term results.

This new article in the Journal of Orofacial pain explores the use of botulinum toxin into the sphenopalatine ganglion.  (Pubmed abstract below)

The study utilizes a personalized custom injection guide.
The use of an injection guide is an enormous plus compared to doing blocks under fluoroscopy or other guided procedure and improves accuracy which is important when utilizing dangerous and potentially fatal injections of Botox

J Oral Facial Pain Headache. 2019 Sep 27.
Sphenopalatine Ganglion Block with Botulinum Neurotoxin for Treating Trigeminal Neuralgia Using CAD/CAM-Derived Injection Guide.

To examine the effectiveness and safety of using a CAD/CAM-derived injection guide for botulinum neurotoxin block of the sphenopalatine ganglion for trigeminal neuralgia treatment.

METHODS:
Ten patients with second-division trigeminal neuralgia who did not respond to submucosal administration of botulinum neurotoxin were enrolled in this study. The target point around the sphenopalatine fossa was determined after fusion of computed tomography data with a scan of a maxillary model using a software program for dental implant surgery. A CAD/CAM-derived injection guide was fabricated. The guide was affixed to the patient’s maxilla, and a needle was inserted to an exactly analyzed depth. Subsequently, 50 units of botulinum neurotoxin were injected. Pain intensity evaluated using a visual analog scale and pain frequency were measured.

RESULTS:
By using the guides, sphenopalatine ganglion block with botulinum toxin was performed 18 times without any complications. The visual analog scale score (8.1 ± 1.0) and pain frequency (19.4 ± 8.8 times/day) decreased (to 1.9 ± 1.4 and 4.9 ± 5.4 times/day, respectively) significantly (P < .001). After 4 weeks, the mean subjective improvement achieved was 77.5% ± 13.8%, and all patients responded to treatment.

CONCLUSION:
Even without prior experience of sphenopalatine ganglion block, the CAD/CAM-derived guide enabled the accurate and safe administration of botulinum neurotoxin to the sphenopalatine ganglion for the treatment of trigeminal neuralgia.

PMID: 31560737 DOI: 10.11607/ofph.2510

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