Treatment of a subtype of trigeminal neuralgia with descending palatine neurotomy in the pterygopalatine fossa via the greater palatine foramen–pterygopalatine canal approach

Objectives We compare estimated blood loss (EBL) during functional endoscopic sinus surgery between patients receiving transoral pterygopalatine fossa and transnasal infiltration (combined) to patients receiving only transnasal infiltration. Variables such as CT-stage, revision surgery, presence of polyps, and operative time are considered. Methods Injection with 1% lidocaine with 1:100,000 epinephrine was performed through the greater palatine foramen and transnasally in the “combined” study group (20 patients) and only transnasally in the control group (22 patients). Charts, operative reports, and CT scans were reviewed and demographic data as well as pertinent information were collected. Patients were followed up and all additional procedures and events were recorded. Results 12 females and 8 males, average age of 48, underwent combined injections; 16 males and 6 females (average age of 50) were in the control group. Using the Wilcoxon/ Kruskal-Wallis Tests (Rank Sums), mean EBL calculated for the combined injection group was 347ml and 493ml for the transnasal injection group (CI 0.95, p=0.093). Average ratio of EBL over OR time was 2.89 ml/min for the combined group and 4.11 ml/min for the control group. We also compare EBL between groups in patients with polyps, endoscopic and CT stage, and revision cases. No complications were reported. Conclusions Combined injection of the pterygopalatine fossa and nasal cavity appears to be a safe and relatively simple method to decrease EBL during sinus surgery, but initial data analysis shows that the difference did not reach statistical significance.

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Pterygopalatine fossa segment neurectomy of maxillary nerve through maxillary sinus route in treating trigeminal neuralgia

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2013.01.002 ◽

2013 ◽

Vol 41 (7) ◽

pp. 652-656 ◽

Cited By ~ 9

Author(s):

Shuangxi Zhu ◽

Qiong Rong ◽

Songling Chen ◽

Xiang Li

Keyword(s):

Trigeminal Neuralgia ◽

Maxillary Sinus ◽

Pterygopalatine Fossa ◽

Maxillary Nerve

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Breast Cancer Metastasis Involving Pterygopalatine Fossa: A Cause of Trigeminal Neuralgia

Headache The Journal of Head and Face Pain ◽

10.1111/j.1526-4610.2004.04178_1.x ◽

2004 ◽

Vol 44 (9) ◽

pp. 927-928 ◽

Cited By ~ 5

Author(s):

Sait Albayram ◽

Ibrahim Adaletli ◽

Hakan Selcuk ◽

Fatih Gulsen ◽

Civan Islak ◽

...

Keyword(s):

Breast Cancer ◽

Trigeminal Neuralgia ◽

Cancer Metastasis ◽

Breast Cancer Metastasis ◽

Pterygopalatine Fossa

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Ultrasound-Guided Trigeminal Nerve Block via the Pterygopalatine Fossa: An Effective Treatment for Trigeminal Neuralgia and Atypical Facial Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/e537 ◽

2013 ◽

Vol 5;16 (5;9) ◽

pp. E537-E545

Author(s):

Mark C. Kendall

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Nerve Block ◽

Trigeminal Nerve ◽

Local Anesthetic ◽

Facial Pain ◽

Case Series ◽

Pterygopalatine Fossa ◽

Atypical Facial Pain ◽

Ultrasound Guided

Background: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. Objective: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting: Academic pain management center. Design: Prospective case series. Methods: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. Results: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations: Prospective case series. Conclusion: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions. Key words: Trigeminal nerve, ultrasound-guided, atypical facial pain, trigeminal neuralgia, tic douloureux.

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Anatomy of greater palatine foramen and canal and pterygopalatine fossa in Thais: considerations for maxillary nerve block

Surgical and Radiologic Anatomy ◽

10.1007/s00276-005-0016-5 ◽

2005 ◽

Vol 27 (6) ◽

pp. 511-516 ◽

Cited By ~ 42

Author(s):

D. Methathrathip ◽

W. Apinhasmit ◽

S. Chompoopong ◽

A. Lertsirithong ◽

T. Ariyawatkul ◽

...

Keyword(s):

Nerve Block ◽

Pterygopalatine Fossa ◽

Maxillary Nerve ◽

Greater Palatine Foramen ◽

Maxillary Nerve Block

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LOCAL ANESTHETIC SPREAD TO THE CONTRALATERAL TRIGEMINAL GANGLION

Pain Management Case Reports ◽

10.36076/pmcr.2019/3/59 ◽

2019 ◽

pp. 59-62

Author(s):

Kim T. Nguyen

Keyword(s):

Trigeminal Neuralgia ◽

Nerve Block ◽

Trigeminal Ganglion ◽

Trigeminal Nerve ◽

Local Anesthetic ◽

Local Anesthetics ◽

Ultrasound Guidance ◽

Pterygopalatine Fossa ◽

Patient Reported ◽

Key Words Trigeminal Neuralgia

Chronic neuropathic pain syndromes can severely affect a person’s quality of life. Trigeminal neuralgia is among these syndromes and involves the mandibular branch of the fifth cranial trigeminal nerve. Patients typically present with facial pain described as electrical and shock-like in nature, exacerbated by movements of the jaw such as talking and chewing. Many patients are unable to achieve adequate relief with medical management and therefore require interventions such as injections of local anesthetics, steroids, or glycerol. One method of injection uses ultrasound guidance for local anesthetic injection in the pterygopalatine fossa affecting the trigeminal ganglion. A 64-year-old woman with a history of trigeminal neuralgia presented for a trigeminal nerve block on her right side via ultrasound guidance. Following the injection, she experienced the desired effect of numbness on her right side in the distribution of the trigeminal nerve. In addition, the patient reported feeling the same effects on her left side despite no injection being done on that side. We describe a unique case in which local anesthetics spread through the pterygopalatine fossa and across the midline, affecting the contralateral trigeminal ganglion. Patients should be monitored for hemodynamic changes following this injection. Key words: Trigeminal neuralgia, trigeminal nerve block, pterygopalatine fossa, regional block, trigeminal ganglion

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A study of greater palatine foramen and its importance in the application of maxillary nerve block in South Indian Population

International Journal of Anatomy and Research ◽

10.16965/ijar.2020.244 ◽

2021 ◽

Vol 9 (9) ◽

pp. 7857-7860

Author(s):

Aravinth Mahesh ◽

◽

Rajesh. S ◽

Keyword(s):

Nerve Block ◽

Hard Palate ◽

Indian Population ◽

Pterygopalatine Fossa ◽

South Indian Population ◽

Maxillary Nerve ◽

Greater Palatine Foramen ◽

South Indian ◽

Maxillary Nerve Block ◽

Greater Palatine Canal

Introduction: The greater palatine foramen (GPF) is located in the posterior part of the hard palate between the articulations of hard palate with the maxilla. GPF continues posteriorly and upwards as greater palatine canal (GPC) which opens in to the inferior wall of pterygopalatine fossa. Exiting the foramen rotendum, maxillary nerve enters the pterygopalatine fossa where it can be blocked. The intraoral route of GPF approach can be preferred for maxillary nerve block because of its low incidence of complications and high success rate. For achieving a painless intra operative period in procedures involving the maxillary region and for tooth extraction achieving a perfect maxillary nerve block is of at most importance. Our present study is aimed at correctly locating the position of GPF, its shape and patency in south Indian population which will be helpful for the intra oral approach of maxillary nerve block through the GPF Materials and Methods: The study was conducted in 30 dry adult skull bones of both sex. The molar relation, shape and the patency of the GPF were observed, the readings were obtained, statistically analyzed and compared with other studies. Results: In our observation on both side of skull, it was noted that GPF was located opposite to the 3rd molar in 90% of cases. Oval shaped GPF is most commonly found in our study which accounts to 53.35% and the overall patency rate for GPF was 95% in our study. Conclusion: Analysis and comparison of data has proven that the position, shape and patency of GPF may vary according to different races. This study has also confirmed that the maxillary nerve block via GPF is relatively safe and easier due to the consistency of the position, shape and the patency of the GPF in south Indian population. KEY WORDS: Greater palatine foramen, maxillary nerve block, regional blocks, Greater palatine canal, pterygopalatine fossa, Maxillary nerve.

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