Ultrasound-guided sphenopalatine ganglion block for effective analgesia during awake fiberoptic nasotracheal intubation: A case report

BACKGROUND Awake fiberoptic nasotracheal intubation(AFNI)is the preferred airway ma-nagement strategy for patients with difficult airways.However,this procedure can cause significant physical and psychological distress.This case report explores the application of a sphenopalatine ganglion(SPG)block as an alternative anal-gesic modality to mitigate the discomfort associated with AFNI.CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion.The patient’s medical history included prior surgery,chemotherapy,and radiation therapy,resulting in signi-ficant jaw impairment and limited neck mobility.Considering the anticipated air-way challenges,AFNI was planned.A SPG block was performed under real-time ultrasound guidance,providing effective analgesia during nasotracheal intuba-tion.CONCLUSION The SPG block represents a promising analgesic approach in AFNI,offering po-tential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.

Bilateral Sphenopalatine Ganglion Block for the Treatment of Post Dural Puncture Headache: A Case Report

Background: Post dural puncture headache (PDPH) is a known and potentially debilitating complication of neuraxial anesthesia that can impede patient recovery. The conventional treatment includes hydration and symptomatic treatment like simple analgesics. Those who have unremitting symptoms following conservative measures are offered an epidural blood patch (EBP). However, EBP, an invasive procedure, is associated with complications in itself. Case: We report a 40-year-old man who experienced PDPH after spinal anesthesia. His symptoms recurred after conservative management was instituted. He was then offered a trans-nasal sphenopalatine ganglion (SPG) block. He had excellent pain relief and did not require an EBP. Conclusion: SPG blocks can be considered early in the treatment of PDPH together with general supportive measures. However, if pain relief is not achieved, an epidural blood patch should still be considered.

Severe Traumatic Brain Injury with Sphenopalatine Artery Ruptured: Case Report and Review of the Literature

Emergency endovascular procedure for external carotid exclusion is required to save patients with life-threatening massive epistaxis from a ruptured sphenopalatine artery secondary to severe traumatic brain injury. We report a case of a 20-year-old pedestrian admitted with a severe traumatic brain injury (TBI) secondary to an automobile (a lorry) road accident at high velocity. He presented to the emergency room in a coma with a Glasgow coma scale of 6/15 and massive epistaxis. He underwent emergency stabilization by sedation and was intubated. Body CT-Scan shows fracture of the palatine and pterygoid plate and multiple fractures of the skull with intracranial right frontal lobe hematoma. CT-Angiography was done immediately and confirmed a rupture of the sphenopalatine artery. The patient died of massive epistaxis while waiting for the endovascular procedure. This is a rare clinical case that needs unusual emergency endovascular management. Arterial embolization in emergency settings should be thought in front of any patient with persistent post-traumatic nose bleeding and be carried out as soon as possible to save the patient’s life.

Analysis of Endoscopic Sphenopalatine Artery Surgery for Refractory Epistaxis

Background: This study aimed to determine the safety and efficacy of sphenopalatine artery (SPA) surgery in patients with refractory epistaxis and to identify factors associated with the indications for surgery to assist clinicians in making prompt and appropriate decisions regarding SPA surgery for refractory epistaxis. Methods: We analyzed 97 consecutive patients with nasal bleeding hospitalized in our institution between April 2009 and March 2018. Clinicopathological characteristics and clinical outcomes were analyzed from retrospective chart reviews. Results: Of the 97 patients, 28 (29 sides) required SPA surgery. There were no differences in sex, anti-coagulant drug or antiplatelet use, hemoglobin concentration, or platelet count between Group A (patients who required surgery) and Group B (patients who did not require surgery). Age (58 vs. 67 years, p = 0.038) and severity of comorbidity (0 vs. 1, p = 0.039) were significantly lower in the surgery group. Patients who were younger and had lower Charlson Comorbidity Index (CCI) scores had more requirements for surgery than those who were older and had higher CCI scores. There was no significant difference between the groups with respect to the proportion of patients receiving blood transfusions;however, the length of hospitalization was significantly longer in Group A than in Group B (8.9 vs. 8 days, p = 0.038). Success rate (non-rebleeding rate) was 89%, comparable to that reported in previous studies. Conclusions: Endoscopic SPA surgery was found safe and effective method with few complications. Younger patients with lower CCI scores were found appropriate for SPA surgery for refractory epistaxis due in part to a lower risk of anesthesia.

Early intervention improves clinical responses to seasonal allergic rhinitis by stimulation in sphenopalatine ganglion(Xinwu acupoint)

OBJECTIVE:To examine the efficacy of early intervention(4 weeks before pollen dispersal)with sphenopalatine ganglion(Xinwu acupoint)stimulation in patients with allergies after the onset of seasonal allergic rhinitis(SAR).METHODS:This is a prospective,randomized and unblinded half-open study.Forty-one SAR volunteers were randomly assigned to either the sphenopalatine ganglion(SPG)acupuncture plus supplementary acupuncture(SPG group)or the sham-SPG acupuncture plus supplementary acupuncture(SA group)stimulation 4 weeks before the onset of allergy season.The changes of the total nasal symptom score(TNSS)and the Rhinoconjunctivitis Quality of Life Questionnaire(RQLQ)scores were measured on the first week in the onset of allergy season.RESULTS:Four patients dropped out due to local hematoma and pain in the SPG and SA groups.The remaining 37 patients continued through to the end of the trial.After early intervention 4 weeks before the onset of allergy season,the sneezing,nasal congestion and itchiness scores in the first week of onset time were significantly lower in the SPG group than in the SA group patients(P<0.001).The RQLQ score obtained at the onset of symptoms indicated that symptoms were more significantly ameliorated in the SPG group than in the SA group(P<0.001).CONCLUSIONS:The results of this study confirmed that early intervention by sphenopalatine ganglion(Xinwu acupoint)stimulation can effectively improve the symptoms and the quality of SAR patients'daily lives.

Analysis on the neurological mechanism of acupuncture treatment in Idiopathic tinnitus based on the theory of “central plasticity”

Recent studies have found that although tinnitus originates from the cochlea,its root lies in the plasticity of the auditory center.In other words,the peripheral auditory system damage causes abnormal excitement and even functional reorganization of the brain stem and cerebral cortex,finally leading to tinnitus progresses and persists in the center.The mechanism of"central plasticity"is related to the physiological characteristics of related brain regions,the characteristics of electrophysiological changes,the changes of central neurotransmitters,and psychological factors.It is speculated that the possible mechanisms of the acupuncture treatment of tinnitus are as follows:1.Acupuncture can alter the level of neurotransmitters 5-HT and GABA in nerve center,that is,GABA increases and 5-HT decreases after acupuncture;2.Acupuncture changes the wrong central pattern of the cerebral cortex caused by tinnitus through strong stimulation,and aids the cerebral cortex adapt to the changes of the internal and external environment to produce benign functional reorganization,in order to treat tinnitus;3.External stimulation of acupuncture can accelerate the contraction of muscle vessels around the ears,accelerate blood circulation and metabolism,and improve the blood supply of the auditory system,thus improving tinnitus.4.Acupuncture can improve or even cure tinnitus by stimulating the acupoint-nerve pathway around the ear,regulating unbalanced neurotransmitters,inhibiting abnormal nerve discharge,correcting wrong auditory pathway patterns,and establishing new auditory pathway nerve conduction patterns.

Anatomical variation of the posterior septal artery leads to refractory epistaxis

Purpose:To report a rare variant of the posterior septal artery(PSA),which supplies blood to the posterior mucosa of the contralateral nasal septum.Case report:A 31-year-old female patient underwent suture removal 14 days after septoplasty and developed left-sided epistaxis 6 h after suture removal.To safely and effectively relieve the patient from epistaxis,the cauterization of the left PSA was performed under general anesthesia.However,24 h after the first surgical hemostasis,the patient experienced epistaxis again in the right nasal cavity.We have reviewed the patient's sinus computed tomography again and found a rare variant of PSA,which is the right-sided PSA passing through a bony canal in the left-sided nasal septum.Discussion:The variant of PSA well explained the failure of the first hemostatic surgery.Therefore,we again performed a cauterization of the right-sided PSA,after which the patient recovered and no further epistaxis occurred.Conclusion:When cauterization of PSA is used to manage posterior epistaxis,it is necessary to pay attention to the possible variation in PSA.

Case of Sluder’s syndrome

A case of Sluder’s syndrome in a female patient,aged 56 years old,suffered from intermittent headache for over 20 years.The therapeutic methods include acupuncture with filiform needle mainly applied to the acupoints on governor vessel,foot-shaoyang meridian and foot-yangrning meridian,the external application of Wuzhuyu(吴茱萸Fructus Evodiae)on Yongquan(涌泉KI1),as well as the pricking and bleeding method with the three-edge needle on Touwei(头维ST8).The alliance of these three therapies co-act on promoting the circulation of shaoyang and yangming meridians and governor vessel and have obtained an satisfactory clinical effect.After treated for 5 weeks,the symptoms all disappeared completely,such as headache,vertigo and discomfort on eyes and they were not recurred in 1-year follow-up.