Ultrasound-Guided Trigeminal Nerve Block via the Pterygopalatine Fossa: An Effective Treatment for Trigeminal Neuralgia and Atypical Facial Pain

Background: Patients presenting with facial pain often have ineffective pain relief with medicaltherapy. Cases refractory to medical management are frequently treated with surgical or minimallyinvasive procedures with variable success rates. We report on the use of ultrasound-guidedtrigeminal nerve block via the pterygopalatine fossa in patients following refractory medical andsurgical treatment.Objective: To present the immediate and long-term efficacy of ultrasound-guided injections oflocal anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain thatfailed pharmacological and surgical interventions.Setting: Academic pain management center.Design: Prospective case series.Methods: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with localanesthetic and steroids placed into the pterygopalatine fossa.Results: All patients achieved complete sensory analgesia to pin prick in the distribution of theV2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia inV1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within5 minutes of the injection. The majority of patients maintained pain relief throughout the 15month study period. No patients experienced symptoms of local anesthetic toxicity or onset of newneurological sequelae.Limitations: Prospective case series.Conclusion: We conclude that the use of ultrasound guidance for injectate delivery in thepterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneousprocedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patientswho have failed previous medical interventions.Key words: Trigeminal nerve, ultrasound-guided, atypical facial pain, trigeminal neuralgia, ticdouloureux.