Procedure Pterygopalatine Ganglion RF Treatment

RF treatment is carried out with the patient in the supine position. The fossa pterygopalatina is identified by  lateral fluoroscopy.  A line is drawn on the skin over the fossa, and the introduction point is chosen just below the arcus zygomaticus (Figure 1).

Figure 1. Radio-frequency treatment of the pterygopalatine ganglion: projection of the metal bar indicates the line over the fossa pterygopalatina.

Procedure

The surrounding skin is disinfected, anaesthetised and covered with sterile drapes. A 100-mm radio-frequency electrode with a 2-mm active tip is introduced slowly. The needle is carefully inserted in a superior and anterior direction towards the anterosuperior point of the fossa pterygopalatina, using lateral fluoroscopy (Figures 2 and 3).

 

Figure 2. Radio-frequency treatment of the ganglion pterygopalatinum: AP view.

The C-arm is now placed in an anteroposterior position; the tip of the canula should be lying just laterally to the nasal wall. The stylet is removed, and a thermocouple RF probe is positioned. The position of the electrode is confirmed by electrostimulation using 50 Hz. It is important to use a 2-mm active tip, otherwise damage can occur to the nervus maxillaries during the lesion. Generally, the patient feels paresthesia on the lateral side and back of the nose at a threshold of 0.4 V.  No paresthesia should be felt in the soft palate or upper jaw since this indicates stimulation of the nervus maxillaris or its branches. After a limited amount of local anesthesia (maximum 1 ml), a lesion is carried out for 60 seconds at 80°C, and this lesion is repeated twice, during which the electrode is inserted further.

 

Figure 3. Radio-frequency treatment of the pterygopalatine ganglion: lateral view. Needle high in the fossa pterygopalatina.

Complications

  • Total destruction of the PPG could result in dryness of the eyes. However, in normal conditions,  RF treatment only aims at a partial lesion of the ganglion.
  • A possible complication is hypesthesia of the palatum molle, which generally disappears after six to eight weeks.
  • A further complication is nose bleeding and swelling of the cheek as the result of a hematoma.
  • A bothersome complication is the accidental lesion of the nervus maxillaris, which can occur when the technique is not carried out properly.

 

Close the survey
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.