Clinical Anatomy of Blockade of the Pterygopalatine Ganglion: Literature Review and Pictorial Tour Using Cadaveric Images

Iwanaga, Joe; Wilson, Charlotte; Simonds, Emily; Vetter, Marc; Schmidt, Cameron; Yılmaz, Emre; Choi, Paul J; Oskouian, Rod J.; Tubbs, R. Shane

doi:10.2739/kurumemedj.ms651001

Cited by 12 publications

(5 citation statements)

References 26 publications

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“…The mechanism of pain relief after SPG block is still not exactly known, although as described in the literature, either mechanical stimulation of sphenopalatine ganglion 31 , 44 , 45 or absorption of local anesthetic through the mucous membrane overlying the ganglia, finally block the parasympathetic mediated vasodilation and relieve headache. 46 The short-term effectiveness of the block can be attributed to the short-lasting mechanical stimulation or pharmacological profile of the local anesthetic used for the SPG block.…”

Section: Discussionmentioning

confidence: 99%

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Dwivedi

Singh

Patel

et al. 2023

Brazilian Journal of Anesthesiology (English Edition)

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Section: Discussionmentioning

confidence: 99%

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Dwivedi

Singh

Patel

et al. 2023

Brazilian Journal of Anesthesiology (English Edition)

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“…In cats, stimulation of the cervical sympathetic trunk decreases both nasal airway resistance and sphenopalatine venous outflow [ 10 , 11 ]. On the other hand, stimulation of the vidian nerve (pterygopalatine ganglion) [ 12 ] can increase both nasal airway resistance and sphenopalatine venous outflow [ 11 , 13 ]. In dogs, it is known that blood from the nasal mucosa drains via two main pathways i.e ., the anterior two thirds via the external (dorsal) nasal vein and posterior one third via the SPV [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

The sphenopalatine vein: anatomical study of a rarely described structure

Iwanaga

Pineda

Miyamoto³

et al. 2023

Anat Cell Biol

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Although in counterpart, the sphenopalatine artery (SPA), has been well described in the medical literature, the sphenopalatine vein (SPV) has received scant attention. Therefore, the present anatomical study was performed. Additionally, we discuss the variations, embryology, and clinical significance of the SPV. Adult cadaveric specimens underwent dissection of the SPV. In addition, some specimens were submitted for histological analysis of this structure. The SPV was found to drain from the sphenoidal sinus and nasal septum. Small tributaries traveled through the nasal septum with the posterior septal branches of the SPA and nasopalatine nerve. The SPA and SPV were found to travel through the sphenopalatine foramen and another tributary was found to perforate the medial plate of the pterygoid process and to connect to the pterygoid venous plexus which traveled lateral to the medial plate of the pterygoid process. The vein traveled through the posterior part of the lateral wall of the nasal cavity with the posterior lateral nasal branches of the SPA and the lateral superior posterior nasal branches of the maxillary nerve. To our knowledge, this is the first anatomical study on the SPV in humans. Data on the SPV provides an improved anatomical understanding of the vascular network of the nasal cavity. Developing a more complete picture of the nasal cavity and its venous supply might help surgeons and clinicians better manage clinical entities such as posterior epistaxis, cavernous sinus infections, and perform endoscopic surgery with fewer complications.

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“…SPG blocking has been described for more than 100 years for the control of headaches and pain in oncology. [ 32 ] The physiological mechanism might be based on parasympathetic modulation that leads to a reversal of cerebral arterial vasodilation. [ 33 ] In contrast, the blockade of the sympathetic neurons of the SPG can control blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report

2022

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Background: Post COVID-19 syndrome (PC-19S) appears to be independent of acute illness severity and humoral response. The involvement of the autonomic nervous system (ANS), expressed by dysautonomia, has been hypothesized as a contributor. Several studies have associated the therapeutic effects of local anesthetics (LA) to their action on the ANS. To the best of our knowledge, this is the first report of therapeutic injections with LA linked to clinical improvement in a patient with PC-19S. Patient concerns and diagnoses: This was a 54-year-old-man with postCOVID-19 symptoms lasting 14 weeks, including fatigue, breathlessness, diarrhea, muscle pain, and emotional lability. Interventions and outcome: Injections of 0.5% procaine in the stellate ganglion (SG) and sphenopalatine ganglion (SPG), and in clinically relevant points in the scalp, thorax, and abdomen were performed 3 times over 3 months. The patient reported progressive improvement and was asymptomatic upon completing the treatment. Prescribed medications were discontinued. The 36-Item Short Form Health Survey (SF-36) score showed significant improvement across all SF-36-domains. Conclusion: Subanesthetic doses of LA injected in clinically relevant points led to rapid and complete symptom resolution in this patient with PC-19S. Targeted LA injections may have therapeutic benefits in PC-19S and in other chronic diseases linked to stress and inflammation.

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Clinical Anatomy of Blockade of the Pterygopalatine Ganglion: Literature Review and Pictorial Tour Using Cadaveric Images

Cited by 12 publications

References 26 publications

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

The sphenopalatine vein: anatomical study of a rarely described structure

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report

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