Transfacial transpterygomaxillary access to foramen rotundum, sphenopalatine ganglion, and the maxillary nerve in the management of atypical facial pain.

Post-traumatic atypical facial pain syndromes are refractory to medical therapy and thus challenging to treat. Some of these patients have a facial causalgia syndrome that may include autonomic as well as trigeminal fibers as the anatomic mediators. A procedure that may be of both diagnostic and therapeutic benefit is a nerve block in the region of the foramen rotundum. This allows access to both the maxillary nerve and the sphenopalatine ganglion. A simple technique developed to perform this procedure is described, and the results in a series of six patients are presented.