Sphenopalatine Ganglion Block and Radiofrequency in Posttraumatic Bilateral Facial Neuropathy: A Case Report

 

Objective: The sphenopalatine ganglion is the largest ganglion of the sympathetic and parasympathetic sensory nervous system. It is located within the pterygopalatine fossa of the skull and has access to the external environment through the nasal mucosa. Clinical studies have characterized the role of sphenopalatine ganglion block in the treatment of chronic pain conditions. Radiofrequency thermocoagulation is a method that uses a device that generates heat through high frequency, producing local damage to nerve tissue and loss of myelinated fibers. Here we describe a clinical case of a facial neuropathy manifested with neuropathic pain after functional rhinoplasty that improved after sphenopalatine ganglion block and radiofrequency.

Case Description: A 32-year-old female underwent a functional rhinoplasty for turbinate hypertrophy six years ago, in the immediate postoperative period, patient presented oppressive pain and a feeling of stiffness toward the base of the nose and malar areas, as well as in the retroocular region. The pain is always present and increases when she exerts considerable effort. It was suspected that the operation that caused the problem was poorly performed and the patient was operated on to perform the rhinoplasty again, however, she did not present any improvement regarding pain. She started pharmacological treatment with oxcarbazepine, duloxetine and amitriptyline without response to the antineuritic drug. Subsequently, a bilateral Gasser ganglion block was performed with pulsed radiofrequency where remission of pain was reported for only one day.

The patient came to our center where post-traumatic bilateral neuropathy was diagnosed. Pain intensity was described as an 8 on the visual analog scale (VAS). She underwent magnetic resonance imaging without pathological findings or vascular contact in the trigeminal nerve. A blockade was first performed by transoral technique with local anesthetic and steroids, observing an immediate response when a VAS 1 was reported, thus corroborating the presumptive diagnosis of bilateral sphenopalatine ganglion neuropathy. Subsequently, at 48 hours, conventional radiofrequency was performed in both nodes of sphenopalatine ganglion under fluoroscopy following the infrazygomatic technique ([Fig. 1]). The procedure is performed without complications and showing immediate response, patient only reported mild hypoesthesia in the retronasal and bilateral malar regions. One week after the intervention, the patient was evaluated showing a VAS value of 2, prescribing only duloxetine and clonazepam as current treatment.

Conclusion: Radiofrequency of the sphenopalatine ganglion is an effective option for relieving chronic facial pain such as post-surgical neuropathies that are resistant to conventional treatments. Before radiofrequency, it is important to perform a previous block with local anesthetic to discern whether the sphenopalatine ganglion is involved in the genesis or maintenance of facial pain. It is recommended that cauterization of turbinates be performed with special care during functional rhinoplasty, since there is a risk of injury to the nerve fillets originating from the sphenopalatine ganglion.

Publication History

Article published online:
15 February 2022

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