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10 Articles in Volume 10, Issue #2
Introduction to a Referred Sympathetic Pain Map
Deconstructing Complex Regional Pain Syndrome
Feedback and Response Regarding ACOEM’s Practice
Psychologists as Primary Care Providers
FDA’s Risk Evaluation and Mitigation Strategies Program
Avoiding Complications From Interventional Spine Techniques
Laser Therapy in the Management of Fibromyalgia
Expanding Ellipsoidal Decompression (EED®) of the Spine
Neurotechnology, Evidence, and Ethics
Sphenopalatine Ganglion Neuralgia Diagnosis and Treatment

Sphenopalatine Ganglion Neuralgia Diagnosis and Treatment

The sphenopalatine ganglion has been infrequently implicated in vague symptoms of the head, face, gums, teeth, neck and back since the early 1900s.
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The implication of the sphenopalatine neurons in producing pain in remotely located sites is likely related to the anatomical connections that play a pivotal role as a relay center of the autonomic nervous system. The superior cervical sympathetic ganglion has a connection with the upper cervical nerve roots. The cervical ganglion has a connection with the sphenopalatine ganglion via the deep petrosal nerve and the sphenopalatine ganglion is connected with the trigeminal nerve through the maxillary nerve. The inter-connections are present for referred pain to occur locally and at distant sites through the sphenopalatine ganglion and upper cervical neurons and thus offers a reasonable hypothesis as to how pain can be referred from the head and face area to the neck and upper back—and, of course, from the back and neck to the face and head, gums, and teeth. Since the sphenopalatine ganglion and its nerve axons are the only ganglion exposed to the environment via the nasal passages, it is reasonable to think that some stimulation of the ganglion neurons that results in headache and other symptoms may be caused by noxious chemicals, viruses, or antigens introduced via the nasal mucosa.

Conclusion

In cases of vague atypical pain patterns, I now include local anesthetic blockade of the nasal mucosa as one of my first routine tests so as to avoid the likelihood of failing to remember doing the test of the sphenopalatine ganglion. The unlikely side effects of the block include allergy to anesthetic, irritation to the nasal mucosa, or epistasis, but it is rarely encountered. Autonomic nervous system stimuli that adversely affect the sphenopalatine ganglion that may cause headache and referred “dental” and musculoskeletal pain should be ruled out early in the diagnostic process before good teeth are extracted, migraine drugs are administered, Indomethycin for SUNCT is given, or interventional procedures for pre-sumed trigeminal neuralgia or Temporal tendonitis11 are undertaken. A clinical trial with 30 patients reported in the Journal of Pain Practice offers some promising results in the utilization of pulsed radiofrequency at the sphenopalatine ganglion for patients suffering intractable and chronic head and face pain.12

Last updated on: December 28, 2011
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