The following information is from the American Migraine Foundation
“The Sphenopalatine Ganglion (SPG) is a group of nerve cells that is linked to the trigeminal nerve, the main nerve involved in headache. THE TRIGEMINAL NERVE IS ALSO KNOWN AS THE DENTIST’S NERVE. THE TEETH, THE PERIODONTAL LIGAMENTS, THE JAW MUSCLES AND THE JAW JOINTS ARE THE LARGEST INPUT OF NOCICEPTION INTO THE TRIGEMINAL NERVOUS SYSTEM.
The SPG, located behind the nose, carries information about sensation, including pain, and also plays a role in autonomic functions, such as tearing and nasal congestion. THE SPHENOPALATINE GANGLION IS ALSO KNOWN AS MECKEL’S GANGLION, THE NASAL GANGLION AND THE PTERYGOPALATINE GANGLION.
ACCORDING TO WIKIPEDIA: ”
The pterygopalatine ganglion OF MECKEL, the largest of the parasympathetic ganglia associated with the branches of the MAXILLARY NERVE is deeply placed in the PTERYGOPALATINE FOSSA, close to the SPHENOPALATINE FORAMEN. It is triangular or heart-shaped, of a reddish-gray color, and is situated just below the maxillary nerve as it crosses the fossa.
The SPHENOPALATINE ganglion supplies the LACRIMAL GLANDS AND PARANASAL SINUSES, THE GLANDS of the mucosa of the NASAL CAVITY AND PHARYNX the GINGIVA and the mucous membrane and GLANDS of the HARD PALATE. It communicates anteriorly with the NASOPALATINE NERVE
The link between the SPG and the trigeminal nerve is important in head pain. If you apply local anesthetics (or numbing medications) to block or partially block the SPG, this can be “helpful in reducing head and facial pain.
THE SPHENOPALATINE GANGLION IS PART OF THE AUTONOMIC NERVOUS SYSTEM AND IS THE LARGEST PARASYMPATHETIC GANGLIA OF THE HEAD. IT ALSO CONTAINS SYMPATHETIC NERVES.
SPG blocks were first described in the 1900’s using a technique involving the application of numbing medication onto cotton swabs then placed into the back of the nose. Another technique used to block the SPG involves using a needle to inject the SPG through an area on the cheek. This process is invasive, and usually requires the use of an x-ray machine to place the injection correctly.
THERE ARE ALSO EASIER METHODS INCLUDING AN INJECTION BY A DENTIST THROUGH THE GREATER PALATINE FORAMEN ON THE ROOF OF THE MOUTH AND A SUPRA-ZYGOMATIC INJECTION THAT IS VERY PREDICTABLE AND EXTREMELY SAFE.
In the last few years, three devices have been FDA approved for performing SPG blocks. ALL THREE OF THESE DEVICES ARE BASICALLY “SQUIRT GUNS” THAT PLACE ANESTHETIC OVER AREA OF THE SPG GANGLION.
These devices involve placing a very thin plastic tube into the nose to insert numbing medication in and around the SPG. These devices, called catheters, may be more effective in reducing head and facial pain than the technique using cotton swabs and are less invasive than the injection technique. THERE IS NO EVIDENCE OF INCREASE EFFECTIVENESS OF THIS TYPE OF DELIVERY OF ANESTHETIC. IN ADDITION, IT CAN BE VERY EXPENSIVE AND REQUIRES A VISIT TO THE DOCTOR OFFICE.
DR IRA L SHAPIRA TEACHES COURSES TO PHYSICIANS AND DENTISTS ON UTILIZING CATHETER TYPE COTTON TIPPED APPLICATORS THAT OFFER CONTINUAL FEED OF ANESTHETIC BY CAPILLARY ACTION. MORE IMPORTANT, THEY CAN BE SELF ADMINISTERED BY THE PATIENT AS OFTEN AS NEEDED PUTTING THE PATIENT IN CHARGE OF THEIR PAIN. AFTER INITIAL APPOINTMENTS PATIENT CAN SELF ADMINISTER BLOCKS FOR ABOUT $1.00 PER BILATERAL APPLICATION.
THE DEVICES:
All three devices are considered catheters, or small thin plastic tubes that are inserted into the body. There are no needles involved, and they are quick, safe, and easy to use. Both the Sphenocath® and Allevio® are similar in that they are thin flexible catheters about 5 centimeters in length and have a very small diameter. These two catheters have an angled tip to assist with anesthetic placement. The catheter of the Tx360® is smaller than the other two, but the length is similar.
All three catheters are attached to a syringe that contains numbing medication. The medication is pushed through the syringe once the catheter is placed into the correct position, and delivers numbing medication to the SPG to help treat headache and facial pain. The Sphenocath® procedure may be done with or without an x-ray machine to help guide the catheter into correct positioning.
I HAVE USED BOTH THE SPHENOCATH AND TX360 AND BOTH ARE VERY GOOD BUT UNLESS THERE IS ALMOST TOTAL NASAL BLOCKAGE THE COTTON TIPPED CATHETER IS , IN MY OPINION FAR SUPERIOR. THE INJECTIONS ARE PROBABLY THE MOST EFFECTIVE APPROACH FOR A SINGLE APPLICATION. THE SELF ADMINISRATION OF SPG BLOCKS IS KEY TO THE HIGHEST LEVEL OF PATIENT CARE.
ACCORDING TO THE AMERICAN MIGRAINE FOUNDATION “Most insurance carries cover SPG block for a variety of headache disorders, but you should speak with your insurance representative to ensure it is covered if your provider performs it.”
WHILE THERE ARE MULTIPLE APPROACHES TO SPHENOPALATINE GANGLION BLOCKS, ONLY THE COTTON TIPPED CATHETER IS EASILY SELF ADMINISTERED BY THE PATIENT AND IS INEXPENSIVE ENOUGH FOR LONG TERM USE, DAILY IF NECESSARY.
THE FOLLOWING PATIENT VIDEOS ARE PATIENTS WHO HAVE EXPERIENCED SPG BLOCKS WITH COTTON TIPPED APPLICATOR CATHETERS: