Work

Thermal radiofrequency of the sphenopalatine ganglion in persistent idiopathic facial pain using a suprazygomatic approach: Case report

Year: 2025

Type: article

Abstract: Introduction: The sphenopalatine ganglion (SPG) is a key structure in the pathophysiology of various craniofacial pain syndromes with autonomic manifestations, integrating parasympathetic, sympathetic, and trigeminal fibers within the trigemino-autonomic reflex. Modulation of these pathways through nerve block or radiofrequency has shown effectiveness in managing pain and associated autonomic symptoms. However, no previous reports have described the use of a suprazygomatic approach for thermal radiofrequency of the SPG. Case report: We present the case of a 70-year-old man with a one-year history of left-sided persistent idiopathic facial pain (PFPS), characterized by paroxysmal exacerbations in the V1-V2 territories, epiphora, and nasal congestion, without evidence of structural lesions or classical neuropathy. After unsuccessful treatment with carbamazepine and a diagnostic Gasserian ganglion block, a suprazygomatic SPG block with 1 % lidocaine was performed, achieving 80 % pain relief lasting four weeks. Upon recurrence of pain, fluoroscopy-guided thermal radiofrequency (TRF) of the SPG (80 °C, 60 s) was conducted, resulting in sustained improvement (NRS 1/10) at six months, with no sensory deficits or adverse effects. This case demonstrated that the suprazygomatic approach provides a safe route to access the pterygopalatine fossa. Conclusion: Thermal radiofrequency of the SPG via the suprazygomatic approach may represent an effective and safe alternative for treating persistent idiopathic facial pain with autonomic features.

Source: Interventional Pain Medicine

DOI: 10.1016/j.inpm.2025.100716

Authors: Fabricio Andres Lasso Andrade, Gabriel Gaviria Suarez, Alejandro Fernández Escobar, Roberto Carlo Rivera Díaz, Denny Marcela Achicanoy Puchana, Javier Esteban Toro-López

Institutions: Universidad Nacional de Colombia, Universidad CES, Universidad Nacional Autónoma de México

Language: English

Topic: Pain Management and Treatment

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $2,400