• - Facial neuralgia (maxillary nerve zone) depending from the second branch of the trigeminal nerve (V)
• - Post Herpes Zoster chronic neuralgia
• - Tumoral Infiltration

Target: Pterygopalatine ganglion, in the pterygoid fossa, lying between maxillary sinus, pterygoid process of shenoid and sphenopalatine foramen.

Procedure:

• - Patient in lateral position
• - Thin axial scan from zygomatic arch to base of nose after i.v. constrat media to Pterygoid fossa and maxillary artery delineation
• - CT fluoroscopy-guided direct puncture from skin to pterygoid fossa with a 20 or 22 G needle
• - Infiltration of 2 mL of lignocaine (Block infiltration) mixed with contrast media (to prove extravascular needle postioning and evaluate diffusion)
• - If pain regresses significantly, neurolysis is performed with 1 mL of pure ethanol

Danger:

• - Maxillary artery puncture is dramatic : due to the zygomatic arch, a bleeding maxillary artery cannot be compressed. I.v. contrast media injection is therefore mandatory for proper maxillary artery delineation.
• - Excessive ethanol injection may diffuse to the orbit, nose or in the infratemporal fossa