Sphenopalatine Ganglion Block (Spg)

            Sphenopalatine ganglion (SPG) blocks have long been used in the treatment of headaches. SPG block has been successfully applied in primary headaches such as cluster headaches, migraine, and trigeminal neuralgia. The sphenopalatine ganglion (SPG) is an extracranial parasympathetic ganglion with both sensory and autonomic fibres. It is known that common symptoms such as nausea, lacrimation and nasal congestion, which are frequently seen in migraine and other primary headache disorders, are caused by parasympathetic nerve activation. Therefore, blocking the SPG, which has a large parasympathetic outlet to the cranial and facial structures, helps to relieve the pain and autonomic features seen in these disorders.

      The procedure requires patient cooperation; therefore, it is performed under local anaesthesia and light sedation. After the patient is placed supine and the necessary antisepsis is applied for the procedure area, under the guidance of C-arm fluoroscopy, the lateral fluoroscopic view of the face is obtained by overlapping the mandibular rami. Skin anaesthesia is created below the zygomatic arch and anterior part of the mandible with 1% lidocaine.

      A 22 or 25-gauge spinal needle with a slightly bent tip is inserted superomedially with lateral fluoroscopic guidance. This view is the main view used when advancing the needle into the pterygopalatine fossa. An anteroposterior (AP) view is obtained intermittently to control the depth of the needle and prevent any damage to the nasal wall. The needle tip should terminate immediately laterally to the ipsilateral nasal wall, displayed in the AP view. Following final needle positioning, 0.2 mL of contrast medium is injected under live fluoroscopic imaging to rule out the intravascular spread and confirm the spread of the contrast agent within the pterygopalatine fossa. Once the site has been confirmed, slowly inject 5ml of the drug mixture consisting of 1% lidocaine with or without dexamethasone.

     If successful in reducing the patient’s pain level is achieved, a valuable and potentially longer-lasting success is achieved by blocking the SPG with the Radiofrequency ablation technique to achieve a longer effect.

     Some complications may rarely occur after the procedure. These may include nosebleeds, cheek hematoma, injury to the maxillary nerve and artery, hypoesthesia, diplopia (double vision), infection, and facial nerve paralysis.

     SPG block is a non-invasive and outpatient procedure performed in an operating room with fluoroscopy. Patients are discharged 3 hours after the procedure.