1. 1. ICCMO THE INTERNATIONAL COLLEGE OF CRANIOMANDIBULAR ORTHOPEDICS BUENOS AIRES MARCH 2017 • SPHENOPALATINE GANGLION BLOCKS • Ira L Shapira DDS, FICCMO, D,ABDSM, D,AAPM
  2. 2. Sphenopalatine Ganglion Pterygopalatine Ganglion Meckels Ganglion Nasal Ganglion Sluder’s Ganglion
  3. 3. Parasympathetic Ganglia of Head
  4. 4. Anatomy PterygoPalatine Fossa SphenoPalatine Ganglion • The Trigeminal Nerve is often called the Dentist’s Nerve. • The Sphenopalatine Ganglion also belongs to Dentistry and is intamately associated with the trigeminal nerve • Dentists are experts in the anatomy of the Trigeminal Nerve
  5. 5. PterygoPalatine Fossa Maxilla and Sphenoid Bone
  6. 6. Sluder’s Neuralgia Sphenopalatine Ganglion Neuralgia • SPG Block First described in 1908 by Sluder • Autonomic Trigeminal Cephalgia • Cluster Headache • TMJ Symptoms • Contact Headache
  7. 7. Positive Side Effects SPG Block • Decreased Blood Pressure • Decreased Anxiety • Feeling of Calm and Well Being • Increased sexual desire and response
  8. 8. History
  9. 9. Limbic System • The limbic system includes the thalamus, hypothalamus and other structures. • Limbic system appears to be the memory site of emotions, including Fear, Anger, Joy, Remorse and of course Pain • Pain is our emotional response to nociceptive input.
  10. 10. Flight or Fight Reflex Acute Stress Reaction Sympathetic Response • Preparation for Action • Release of Catecholamines • More blood flow to brain and muscles • Shut Down of Parasympathetics • Less blood to gut
  11. 11. Fight of Flight Response • Adrenal Medula Releases Catecholamines Epinephrine and Norepinephrine • Hans Selye: General Adaptation Syndrome • Stage 1: Alarm • Stage 2: Resistance • Stage 3: Exhaustion
  12. 12. Parasympathetic Response: This is where we Eat and Digest, Sexual Response, Orgasm, Post- Orgasmic Bliss. Survival as a Species rather than an Individual. Feelings of love and Attachment Warm feelings from Babies, Puppies and Kittens FEED AND BREED RESPONSE
  13. 13. Reticular Activating System The reticular activating system is receives input from all parts of the sensory system as well as the cerebrum. • Amplification of input particularly concern to NMD is the Trigeminal Nerve • The major function of this system is to control the arousal level of the brain. Part of Limbic System • This system secretes norepinephrine and dampens the many stimuli coming through it, so new and different stimuli can be recognized by the rest of the brain.
  14. 14. Hypothalamus • Part of Limbic System • Links Nervous System to Endocrine System and Pituitary Gland • Controls Body Temperature, Hunger, Thirst Satiety, • Fatigue, Sleep and Arousal, Circadian Rhythms: Suprachiasmatic Nucleus • Memory and Learning • Blood Pressure, Heart Rate, GI Mobility
  15. 15. Sphenocath & Allevio
  16. 16. TX-360 s
  17. 17. Transnasal cotton tipped Applicator