Open AccessAn Unusual Challenge in Performing Sphenopalatine Ganglion Block with Enlarged Coronoid Process: J acob's Disease
Author(s) -
Zarembinski Christopher,
GraffRadford Steven
Publication year - 2014
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12302
Subject(s) - medicine , coronoid process , process (computing) , ganglion , anatomy , surgery , computer science , elbow , operating system
Objectives Sphenopalatine ganglion block for the treatment of cluster headache has been well‐described for medically refractory cases. Technical challenges in performing this procedure via the mandibular notch can be found in patients with elongation of the coronoid process. Objectives include correlation of physical exam findings and computed tomography ( CT ) imaging, followed by recommendations for future treatment. Methods Case report. Results Patient had a history of cluster headache and a 35 mm interincisal opening. Initially, sphenopalatine ganglion block could not be performed via standard mandibular notch approach due to the inability to advance past superficial tissues. Subsequent CT scan revealed a congenitally enlarged coronoid process with a shortened ramus. Usage of a bite block facilitated completion of the sphenopalatine block on subsequent visit. Conclusions Patients with diminished oral interincisal opening and deviation of the jaw to one side are consistent with J acob's disease. Using a bite block in these patients may be critical to completion of the procedure.