Abstract
Background: The sphenopalatine ganglion (SPG) is a parasympathetic ganglion that’s implicated in multiple primary headache disorders. Current techniques are inconsistent or require imaging. A suprazygomatic approach is thought to be safe and effective. The main objectives are to determine an accurate depth and needle angulation to perform SPG blocks safely and effectively. Methods: Cranial computerized tomography was obtained from 40 Caucasians (20 male, 20 female). For each patient, a line is drawn from the frontozygomatic angle to the pterygomaxillary fissure (PMF) to represent length. Intersection of the line in both transverse and coronal Frankfurt planes create inferior and posterior angulations, respectively. A cadaver dissection is performed to validate the needle placement utilizing these measurements. Contrast fluoroscopy is utilized to verify needle placement in PMF. Results: The mean length was 24.9 +/- 2.8mm for males and 23.8 +/- 0.5mm for females. The difference was statistically significant (p = .019). In patients younger than 40 years, the mean length was 24.5 +/- 2.8mm. In patients greater than 40 years, the mean length was 26.1 +/- 3.1mm. The difference was statistically significant (p = .018). Both inferior and posterior angles were not statistically different between sex or age. Post-contrast imaging confirmed presence of dye in the PMF. Conclusion: While there is a difference in depth between sex and age groups, it’s likely not clinically significant. A depth of 25mm angulated at 6 degrees inferior and 27 degrees posterior is likely generalizable. Bony landmark-based, suprazygomatic SPG blocks via the PMF are probably feasible, safe with minimal risk and may be an option in special patient populations and/or circumstances.
Highlights
The sphenopalatine ganglion (SPG) is the largest, extracranial, predominately parasympathetic ganglion 1
The SPG is located within the pterygopalatine fossa (PPF), which is an inverted pyramid- shaped depression deep to the infratemporal fossa, and accessible through the pterygomaxillary fissure (PMF) 2
The main objective of this study is to identify a reproducible, safe and reliable access pathway via a suprazygomatic approach to target the SPG located in the PPF
Summary
The sphenopalatine ganglion (SPG) is the largest, extracranial, predominately parasympathetic ganglion 1. It is primarily innervated by the greater petrosal branch of the facial nerve, a parasympathetic branch, which originates in the superior salivary nucleus in the dorsal pons. The SPG is located within the pterygopalatine fossa (PPF), which is an inverted pyramid- shaped depression deep to the infratemporal fossa, and accessible through the pterygomaxillary fissure (PMF) 2. It is located between the pterygoid process and the maxillary tuberosity close to the apex of the orbit. The main objectives are to determine an accurate depth and needle angulation to perform SPG blocks safely and effectively
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