An unusual challenge in performing sphenopalatine ganglion block with enlarged coronoid process: Jacob's disease

Abstract

Objectives: Sphenopalatine ganglion block for the treatment of cluster headache has been well-described for medically refractory cases. Technical challenges in performing this procedure via the mandibular notch can be found in patients with elongation of the coronoid process. Objectives include correlation of physical exam findings and computed tomography (CT) imaging, followed by recommendations for future treatment. Methods: Case report. Results: Patient had a history of cluster headache and a 35mm interincisal opening. Initially, sphenopalatine ganglion block could not be performed via standard mandibular notch approach due to the inability to advance past superficial tissues. Subsequent CT scan revealed a congenitally enlarged coronoid process with a shortened ramus. Usage of a bite block facilitated completion of the sphenopalatine block on subsequent visit. Conclusions: Patients with diminished oral interincisal opening and deviation of the jaw to one side are consistent with Jacob's disease. Using a bite block in these patients may be critical to completion of the procedure. © 2014 Wiley Periodicals, Inc.