Bloqueo ganglio esfenopalatino

Bloqueos nerviosos en síndromes de dolor cráneo-facial, migraña y neuralgias

Los síndromes de dolor cráneo-facial crónicos (migraña, jaqueca, cefalea mixta, neuralgias primarias) muchas veces no responden satisfactoriamente al tratamiento general y farmacológico. En estas ocasiones y en casos seleccionados puede plantearse la realización de Bloqueos Nerviosos en regiones anatómicas determinadas de la cara, cuero cabelludo y cuello.

Estos tratamientos son realizados en general con anestésicos locales, con paciente despierto y de manera ambulatoria. La correcta identificación del síndrome doloroso y sus variantes en cada paciente es fundamental para poder ofrecer la mejor alternativa de bloqueo.

Los tipos más frecuentes de bloqueos incluyen:

  • Bloqueos de ramos primarios del nervio trigémino:

Tras la evaluación clínica y de exámenes, a algunos pacientes con síndromes e historia médica específica se les podrá proponer un bloqueo de las ramas Maxilar y/o Mandibular del nervio trigémino (ramas II y III), unilateral o bilateralmente de acuerdo al síndrome a ser tratado. Mediante parámetros anatómicos y en general con guía por ultrasonido (ecografía), con el uso de anestésicos locales, antiinflamatorios esteroidales de depósito y/o toxina botulínica utilizando microcánulas o agujas muy finas para tal propósito, realizando las infiltraciones en relación a la fosa pterigomaxilar

                     Ramos nervio trigémino

 

  • Bloqueos de ramos terminales del nervio trigémino

    Bloqueo nervio aurículo-temporal

Nervio supratroclear y supraorbitario, puntos de bloqueo

     Ramos terminales nervio trigémino

 

 

 

 

 

 

 

 

El bloqueo de uno o más ramos terminales, más superficiales que los ramos primarios, del nervio trigémino de manera uni o biltareal puede ser indicado en pacientes con síndromes neurálgicos, cefaleas mixtas y cefaleas con componente autonómico y muchas veces se realiza en conjunto con bloqueos de ramos primarios o ganglionares. Dentro de estas ramas se encuentran los nervios supraorbitario, supratroclear, infraorbitario, alveolares, aurículotemporal y mentoniano. En muchas ocasiones el bloqueo de estos ramos logra una reducción significativa de los cuadros dolorosos crónicos y la yugulación de crisis agudas.

 

  • Bloqueos de ganglios parasimpáticos (esfenopalatino)

El ganglio esfenopalatino o pterigopalatino se relaciona con la segunda rama primaria del nervio trigémino (ramo maxilar) y se ubica en la fosita pterigopalatina, medial a la fosa temporal. Existen varias forma de realizar un bloqueo en este ganglio (desde la fosa nasal con hisopo, por punción supra o infracigomática, entre otras). Los bloqueos de este ganglio tienen las mismas características en cuanto a fármacos y técnicas en general y suelen tener resultados de mayor duración en casos seleccionados en especial los bloqueos realizados por punción lateral directa, usando muchas veces guía ecográfica o radioscópica. Se utiliza para casos refractarios de ciertas migrañas, neuralgias, cefaleas cluster o en racimo, cefaleas con componente autonómico mayor, cefalea post-punción, entre otras.

 

Esquema y ecografía bloqueo esfenopalatino

Guía ecográfica bloqueo ganglionar

 

 

 

 

 

 

 

 

Bloqueo mediante hisopo de ganglio esfenopalatino

 

Bloqueo ganglio esfenopalatino

Bloqueo ganglio esfenopalatino

 

 

  • Bloqueos de nervios occipitales 

Los nervios occipitales mayores y menores se originan en la región posterior del cuello y la nuca, desde los nervios cervicales superiores. Estos nervios originan varios síndromes dolorosos bien caracterizados, uno de ellos la llamada neuralgia de Arnold o neuralgia del nervio occipital mayor, cuadro que es frecuente motivo de bloqueos nerviosos de mínima invasión. El bloqueo de nervios occipitales también ha sido reconocido como una alternativa de tratamiento eficaz en otros síndromes dolorosos, entre ellos la cefalea de Horton (cluster o en racimos)

 

Nervios occpitales

 

Esquema de bloqueo nervios ocipitales

 

 

 

 

 

 

 

 

 

Existen múltiples otros puntos de bloqueo en distintas regiones de la cara, cuero cabelludo y región cervical anterior y posterior que pueden ser empleados de manera individual o en conjunto con las técnicas antes mencionadas, así como infiltraciones en base de toxina botulínica en regiones más amplias para determinados síndromes dolorosos. En general todos estos procedimientos comparten las características de ser de mínima invasión, ambulatorios, con anestésicos locales y guía anatómica y ultrasonográfica en pabellón ambulatorio o sala de procedimientos ad hoc de cada institución de salud.

Ante dudas y para solicitud de atenciones médicas contáctenos a través de nuetros Formularios, WhatsApp o Email

 

NeuroMed
Categoría
Bloqueos nerviosos e infiltraciones

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