Open AccessLOCAL ANESTHETIC SPREAD TO THE CONTRALATERAL TRIGEMINAL GANGLION
Author(s) -
Kim Nguyen
Publication year - 2019
Publication title -
interventional pain management reports
Language(s) - English
Resource type - Journals
ISSN - 2575-9841
DOI - 10.36076/pmcr.2019/3/59
Subject(s) - trigeminal neuralgia , medicine , pterygopalatine fossa , trigeminal nerve , trigeminal ganglion , anesthesia , local anesthetic , anesthetic , ganglion , orofacial pain , surgery , anatomy , psychology , neuroscience , skull , sensory system
Chronic neuropathic pain syndromes can severelyaffect a person’s quality of life. Trigeminalneuralgia is among these syndromes and involvesthe mandibular branch of the fifth cranialtrigeminal nerve. Patients typically present withfacial pain described as electrical and shock-likein nature, exacerbated by movements of the jawsuch as talking and chewing. Many patients areunable to achieve adequate relief with medicalmanagement and therefore require interventionssuch as injections of local anesthetics, steroids,or glycerol. One method of injection uses ultrasoundguidance for local anesthetic injection inthe pterygopalatine fossa affecting the trigeminalganglion.A 64-year-old woman with a history of trigeminalneuralgia presented for a trigeminal nerve block onher right side via ultrasound guidance. Followingthe injection, she experienced the desired effectof numbness on her right side in the distributionof the trigeminal nerve. In addition, the patientreported feeling the same effects on her left sidedespite no injection being done on that side.We describe a unique case in which local anestheticsspread through the pterygopalatine fossaand across the midline, affecting the contralateraltrigeminal ganglion. Patients should be monitoredfor hemodynamic changes following this injection.Key words: Trigeminal neuralgia, trigeminalnerve block, pterygopalatine fossa, regional block,trigeminal ganglion