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Lingual and Inferior Alveolar Nerve Damage Discussion Site

Subject: "Sphenopalatin Ganglion Block???"     Previous Topic | Next Topic
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Conferences Treatments for Lingual or Inferior Alveolar Nerve Damage Topic #541
Reading Topic #541
pim
Member since Oct-19-06
225 posts
Apr-01-08, 05:18 PM (CST)
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"Sphenopalatin Ganglion Block???"
 
   Anyone have any experience with this? It sounds better than the Stellate Ganglion Block where they inject a long needle into your neck. My neuro said that stellate ganglion blocks don't work for face pain because it is "upstream" of the injection site.

http://www.csmc.edu/12371.html

http://www.deaconess.com/body.cfm?id=1917


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  Subject     Author     Message Date     ID  
  RE: Sphenopalatin Ganglion Block??? MaverickDMD Apr-02-08 1
     RE: Sphenopalatin Ganglion Block??? pim Apr-02-08 2
         RE: Sphenopalatin Ganglion Block??? MaverickDMD Apr-02-08 3
             RE: Sphenopalatin Ganglion Block??? pim Apr-02-08 4
                 RE: Sphenopalatin Ganglion Block??? MaverickDMD Apr-05-08 5
                     RE: Sphenopalatin Ganglion Block??? pim Apr-05-08 6
                         RE: Sphenopalatin Ganglion Block??? MaverickDMD Apr-06-08 7
                             RE: Sphenopalatin Ganglion Block??? pim Apr-09-08 8
                                 RE: Sphenopalatin Ganglion Block??? Dr B Apr-09-08 9
                     RE: Sphenopalatin Ganglion Block??? pim Apr-21-08 14
  RE: Sphenopalatin Ganglion Block??? CJ Apr-16-08 10
     RE: Sphenopalatin Ganglion Block??? pim Apr-17-08 11
         RE: Sphenopalatin Ganglion Block??? CJ Apr-17-08 12
             RE: Sphenopalatin Ganglion Block??? edgaras Apr-21-08 13
                 RE: Sphenopalatin Ganglion Block??? CJ Apr-22-08 15
                     RE: Sphenopalatin Ganglion Block??? MaverickDMD Apr-25-08 16
                     RE: Sphenopalatin Ganglion Block??? charlottefr Apr-29-08 17
                         RE: Sphenopalatin Ganglion Block/TO ALL Bob Apr-29-08 18
                             RE: Sphenopalatin Ganglion Block/TO ALL edgaras Apr-30-08 19
                                 RE: Sphenopalatin Ganglion Block/TO ALL pim May-01-08 20
                         RE: Sphenopalatin Ganglion Block??? CJ May-09-08 21

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MaverickDMD
Member since Dec-14-07
84 posts
Apr-02-08, 02:54 PM (CST)
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1. "RE: Sphenopalatin Ganglion Block???"
In response to message #0
 
   The pterygopalatine ganglion block as it is called in today's world involves inserting a very long needle into the back of the mouth about 1.5 inches higher up than the back of the last upper molar. It's pretty extreme. The PP ganglion does not affect pain sensation only sympathetic and parasympathetic secretomotor function to the nose and lacrimal gland. You seem to be suffering with a V3 injury (mandibular division branches from the trigeminal) so a block that affects VII and V2 would do nothing here except stop you from crying about it. And, further, what if a needle injury occurs here?


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pim
Member since Oct-19-06
225 posts
Apr-02-08, 06:23 PM (CST)
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2. "RE: Sphenopalatin Ganglion Block???"
In response to message #1
 
   I'll look past your "crying about it" comment and assume it wasn't meant the way it came across.

From what I've read this is done by inserting hollow "Q-tips" into your nose and dripping Lidocaine and whatever other drugs into the nasal passage. The needle injury was a huge concern with the Stellate Ganglion Block. What was "appealing" to me about this is that there is no needle.

Are we talking about the same thing? If they don't block pain what do they do? Why do they use it for pain management?


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MaverickDMD
Member since Dec-14-07
84 posts
Apr-02-08, 06:44 PM (CST)
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3. "RE: Sphenopalatin Ganglion Block???"
In response to message #2
 
   The crying reference was to the neural blockage of the lacrimal (tear) gland, i.e., no tears would be made if the neural stimulus were blocked by anesthesia. The pterygopalatine ganglion is a relay area between the facial nerve (VII) and the maxillary branch of the trigeminal nerve(V). It does not carry any sensory nerves so it would be odd to use a block here to reduce pain in the upper jaw. However, the PP ganglion and perhaps the otic ganglion (again nonsensory) are thought to be involved in the ice cream headache phenomenon which hurts like hell as we all know. So it is probably that the PP ganglion when excited will create sensory phenomena in neighbouring areas much like when getting the wind knocked out of you -- the celiac ganglion, aka, the solar plexus, causes a cascade of nerve impulses to many areas of the body. I followed your posted links and noted that the prescribed procedure involved what appears to be EMLA (prilocaine and lidocaine) gel to get a topical effect through the mucosa to the ganglion itself. Again, from what I recall about your particular plight, you're having issues in the lower jaw not the upper, so in my humble view, I found it questionable as to the efficacy you would have in a V3 injury. But again, I'm not a neurologist so what the hell do I know. One last thing that might be interesting is that in particular to lingual nerve injuries that produce dysesthesias, it is often thought to be linked to the chorda tympani injury, the branch of VII that carries taste fibers but also carries parasympathetic fibers that have been implicated in the substance P and glutamic acid mediated pain
pathways, and not the lingual nerve itself that causes the bizarre pain episodes. Since the pterygopalatine ganglion relays between parasympathetic afferents of VII and V it may have been a suggestion for treatment. (But again, don't you have an IA problem and not a lingual nerve problem?).


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pim
Member since Oct-19-06
225 posts
Apr-02-08, 08:13 PM (CST)
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4. "RE: Sphenopalatin Ganglion Block???"
In response to message #3
 
   That's too much medical-speak for me! Sorry about the misinterpretation.

The post operative report says "injury to cranial nerve V, division III on the left".

This wasn't offered to me as an option by a doctor. Someone told me about someone else having it done for a dental injury and suggested I look into it. I have not yet heard if it helped the other person.

My "medicated" pain has been increasing over the last 3 weeks and I don't understand why - emotional intolerance? medication intolerance? something going on with the nerve?


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MaverickDMD
Member since Dec-14-07
84 posts
Apr-05-08, 00:03 AM (CST)
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5. "RE: Sphenopalatin Ganglion Block???"
In response to message #4
 
   My worry is that once you enter the medical system, their knowledge or appreciation of the anatomy of the mouth diminishes. A diagnosis of "injury to cranial nerve V division III left" is about as rudimentary as it gets as any 1st year dental student could have come up with that diagnosis. Everyone here thinks that once they get out of the dental system and into the medical system that they will be finally in the care of someone who knows what they're doing. This is sad as it gives the patient a false hope and the practitoner a false sense of wisdom.

Unfortunately, I don't have any advice to give you about medicated pain as I'm not qualified on that front. I'm just a lowly general practice dentist who is applying his training to help others. This is a new frontier for most practitioners and I would think that most who have experience in treating these disorders are still at the mercy of the lack of studies in this field. I think that the experience of yours and others will add to the field of knowledge and benefit others that come after you.


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pim
Member since Oct-19-06
225 posts
Apr-05-08, 08:00 AM (CST)
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6. "RE: Sphenopalatin Ganglion Block???"
In response to message #5
 
   That wasn't the sum total of the post-op report. That report was done by a micro oral surgeon who specializes in cancer of the jaw/mouth. I went to him because he has alot of experience dealing with nerves because of his speciality (or atleast a fair part of his practice). I trusted his input WAY MORE than what I was told by the Sargenti using dentists...which was to give me a shot of decadron inside my mouth and wait for the massive overfill (7mm) to resorb. Wasn't sure what I was supposed to be most excited over - resorbing the formaldehyde, the lead or the mercury. I was already on oral steroids and once their recommendation was made (after I had to badger the overfill material out of the unwilling practice owner) I already knew that their inputs were more less than honorable and more to cover their own tails than to help me.

When people act like they have something to hide, they usually do.


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MaverickDMD
Member since Dec-14-07
84 posts
Apr-06-08, 02:42 AM (CST)
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7. "RE: Sphenopalatin Ganglion Block???"
In response to message #6
 
   LAST EDITED ON Apr-06-08 AT 02:46 AM (CST)
 
Well I think that any practitioner would have done the same for you after the fact. The problem is that there is a perception that somebody is withholding the appropriate treatment in these cases and the patient feels left in the lurch. The fact remains, that nobody knows what is appropriate -- steroids are what I would have given you right off the bat as would anyone, but after that, it is a waiting game which is frustrating for both patient and practitioner. For the first time I think I agree with Dr B --whoever that fucker who used Sargenti on you should be hung out to dry. Other than that, I feel helpless as to how I can help you further, but let me know it I can.


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pim
Member since Oct-19-06
225 posts
Apr-09-08, 12:38 PM (CST)
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8. "RE: Sphenopalatin Ganglion Block???"
In response to message #7
 
   And they still use it....with the state board ordered informed consent. So they "ask" the patient if they can negligently treat them below the standard of care before they do.

What do you want to bet that they NEVER tell them about me?

I truely understand that no one knows what to do with me. Its 2.5 years out and exactly the same today as it was right after the procedure. I am not the same person professionally or personally that I used to be. I'm close to having to give up the best assignment that I have had in 20 years because I can't multi-task like I used to, I get easily confused, I say and do stupid things, and I've even forgotten who coworkers are (ones that I worked with for YEARS). Unfortunately, I can't schedule my near nervous breakdowns around my work schedule. Stress makes the pain worse which leads to those near nervous breakdowns. The meds have their part in this also. I've been in such despair because of the pain that my husband has moved the guns. Unmedicated this pain is unlivable. And this is all because of a toothache.


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Dr B
Member since Oct-6-06
698 posts
Apr-09-08, 05:41 PM (CST)
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9. "RE: Sphenopalatin Ganglion Block???"
In response to message #8
 
   I often see vague descriptions of oral nerve pain in the reports I read too. As far as MD's go, pain clinics and neurologists do use many kind of drugs that most dentists will not. As far as other treatments, I rarely see any. If you really spend a lot of time here and read, you'll find that some people have found medical "cocktails" that have been effective. Many go through Hell with side effects of these drugs but many times they accomodate and are helped by them.
As far as some of the needle type blocks, I think I would be terrified to go that route.

Dr B


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pim
Member since Oct-19-06
225 posts
Apr-21-08, 05:22 AM (CST)
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14. "RE: Sphenopalatin Ganglion Block???"
In response to message #5
 
   BTW - it was an Oral Surgeon who did my surgery. He is well respected and graduated top in his class. He also knew it was Sargenti Paste before he did the surgery...actually before I ever saw him. I will forever respect him for his compassion to patients as most doctors would not have touched me with a 10' pole, including shrinks.


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CJ
Member since Oct-2-06
974 posts
Apr-16-08, 03:23 PM (CST)
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10. "RE: Sphenopalatin Ganglion Block???"
In response to message #0
 
   Hi Pim,
I havnen't been on the site for awhile now, but I just saw this post. I was given a sphenopalatin block with a very long q-tip at a pain clinic several years ago. It intailed laying down and having this very long q-tip inserted down the injured side of my nose or I should say the injured side of my face. It was dripping with very strong lidocaine. I waited about 15 minutes and then another application was made.
Believe it or not, it did lesson my pain which is from injections of Septocaine in the palate of my mouth. The pain extends down the side of my nose, right eye, right cheek bones, and right ear and bone behind the ear. I also have lost two teeth by the area. There is a lot of bone loss there and no where else in my mouth. Finally I had the teeth out as they were hurting all the time. As I said, the nerve q-tip block lessoned my pain for several days. However, this type of procedure cannot be done on a constant basis and is more for diagnostics than anything else. I do have a lidocaine nose spray which I use occasionally when I am in severe pain along with my usual meds that I take on a regular basis for the pain.
CJ


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pim
Member since Oct-19-06
225 posts
Apr-17-08, 06:55 AM (CST)
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11. "RE: Sphenopalatin Ganglion Block???"
In response to message #10
 
   CJ,

Thanks for the info. I knew of someone else with a dental injury that had it done and it did not help. I don't know where that person's pain is.


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CJ
Member since Oct-2-06
974 posts
Apr-17-08, 09:10 AM (CST)
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12. "RE: Sphenopalatin Ganglion Block???"
In response to message #11
 
   The main thing to is that it is not a permanent solution to the pain. However, the lidocaine spray does help sometimes. But I do not think that would be enough of a pain reliever unless the pain was mild.
CJ


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edgaras
Member since Oct-14-06
282 posts
Apr-21-08, 02:38 AM (CST)
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13. "RE: Sphenopalatin Ganglion Block???"
In response to message #12
 
   LAST EDITED ON Apr-21-08 AT 02:43 AM (CST)
 
Couldn't help but wonder - where the ganglion is located.


Ablate Ablate Ablate. No Ganglions No Pain?


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CJ
Member since Oct-2-06
974 posts
Apr-22-08, 01:27 PM (CST)
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15. "RE: Sphenopalatin Ganglion Block???"
In response to message #13
 
   It is near wear the sphenoplatin ganglion is shown on this drawing where he gave me injections in the palate of my mouth. (the roof of my mouth in the back.) I have several other areas involved with pain, not just that area. I was told by a pain specialist/neurologist who just recently retired, that anything that disturbs the nerves that have already been damaged has a huge potential to make the pain worse and also bring on a condition, I can't remember the name, but it is where nothing will work to lesson the pain because of repeated injuries to the nerve. And it has been damaged so many times, it cannot repair itself. He warned against any surgery, or any invasive techniques of any kind, even nerve block injections.
CJ


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MaverickDMD
Member since Dec-14-07
84 posts
Apr-25-08, 01:39 AM (CST)
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16. "RE: Sphenopalatin Ganglion Block???"
In response to message #15
 
   Thanks for your input. I explained this about a month ago.


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charlottefr
Member since Feb-22-08
150 posts
Apr-29-08, 03:33 AM (CST)
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17. "RE: Sphenopalatin Ganglion Block???"
In response to message #15
 
   Have you had any furthur dental work done since your injury, CJ? This is still one of my biggest fears..that my nerve might be re-injured in a future procedure.

It makes sense that repeated injuries to the nerve can't be a good thing


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Bob
Member since Aug-6-07
82 posts
Apr-29-08, 11:51 PM (CST)
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18. "RE: Sphenopalatin Ganglion Block/TO ALL"
In response to message #17
 
   I just want to remind everyone who is suffering that acupuncture has worked better than anything else I've tried for my lingual nerve damage and resultant paresthesia. It is the only therapy I know of that is able to stimulate the normal physiology (function) of nerves without causing any further damage to them or severe side effects. It works by stimulating signals within your own body, nothing artificial (such as a drug or electricity) is added, so it is naturally very biocompatable. It has the effect of reducing inflammation, relieving pain, and stimulating micro circulation for healing. Of course it must be done properly but if so you needn't worry about side effects or further damage to whatever nerve you are trying to heal. Most often repeated treatments are recommended to achieve theraputic and long lasting relief, although each case is different and some will respond immediately while others can take weeks. Good luck to everyone who suffers... you are not alone.


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edgaras
Member since Oct-14-06
282 posts
Apr-30-08, 10:04 PM (CST)
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19. "RE: Sphenopalatin Ganglion Block/TO ALL"
In response to message #18
 
   Do you mind telling us approximate area where the needles are inserted for perform such treatment?


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pim
Member since Oct-19-06
225 posts
May-01-08, 10:13 AM (CST)
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20. "RE: Sphenopalatin Ganglion Block/TO ALL"
In response to message #19
 
   The articles I read about this talked about the patient lying down with tilted, putting straws in their nose and dripping the medication into the straws.


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CJ
Member since Oct-2-06
974 posts
May-09-08, 11:18 PM (CST)
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21. "RE: Sphenopalatin Ganglion Block???"
In response to message #17
 
   Charlottefr,
Yes, I have had future dental work done, of course not by the dentist who did the injury.

It has been and is still terribly difficult to have any dental work done since my injury. But if needed work is put off too long, it can result in more work that will need to be done or possibly loosing more teeth.

I've actually lost more teeth by the injury site. Over the years since the injury there has been a lot of bone loss occuring there and the teeth hurting and I finally had them out. It did increase my pain for several weeks and I even had to make a trip to the ER, like in the beginning days of the injury, because of the added pain from the extractions.

But if I were you, I would not put off any needed dental work. Try to find a dentist you can talk too about your concerns and is willing to work with you.

Best Wishes,
CJ


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