ArticleRegional anesthesia and pain medicine2026
Transnasal spread of bupivacaine into the pterygopalatine fossa following endoscopically assisted cotton swab placement: a cadaveric study.
Article in Regional anesthesia and pain medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Infraorbital-Infratrochlear Versus Transnasal Sphenopalatine Ganglion Block for Septorhinoplasty: A Prospective, Randomized, Double-Blind, Clinical Trial.Journal of clinical medicine · 2026Article
- Tension-Type Headache: Toward an Integrative Multidimensional Framework for Clinical Stratification and Personalized Management.Journal of clinical medicine · 2026Review
- Clinical Practice Patterns in the Physiotherapy Management of Tension-Type Headache Among Spanish Physiotherapists.Journal of clinical medicine · 2026Article
- Effects of Spinal Manipulation and Dry Needling on Headache and Migraine: A Systematic Review of Randomized Controlled Trials.Journal of clinical medicine · 2026Review
- Triptan Use and Potential Undertreatment in Migraine: A Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- Integrative Migraine Therapy: From Current Concepts to Future Directions-A Plastic Surgeon's Perspective.Medicina (Kaunas, Lithuania) · 2025Review
- Injectate distribution patterns in posterior infrazygomatic and transoral approaches to the pterygopalatine fossa.Korean journal of anesthesiology · 2025Article
- Spatiotemporal dynamics of local anesthetic diffusion in nerve revealed by a 2D computational model.Biophysical journal · 2025Article
- Evaluation of Personality Profiles in Cluster Headache Patients: A Comparative Analysis with Migraine Patients Using the Minnesota Multiphasic Personality Inventory-3.Journal of clinical medicine · 2025Article
- A Scoping Review of Clinical Features and Mechanisms of Orofacial Pain and Headache in Patients with Head and Neck Cancer.Journal of clinical medicine · 2025Review
- Efficacy of Greater Occipital Nerve Blockade in Craniofacial Neuralgia and Facial Pain Syndromes: A Retrospective Chart Review with Prospectively Collected Follow-Up Data.Journal of clinical medicine · 2025Article
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Authors and funding
5 authors.
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Abstract
backgroundThere are conflicting data on the efficacy of transnasal topical anesthetic approaches intended to achieve a pterygopalatine ganglion block, specifically regarding the extent to which local anesthetics reach the pterygopalatine fossa. This cadaveric study aims to determine whether bupivacaine can reach the pterygopalatine fossa following topical administration near the sphenopalatine foramen using endoscopically assisted cotton ball placement.
methodsNine fresh cadavers underwent topical nasal administration of a solution containing bupivacaine, methylene blue, and iodine contrast. Under direct endoscopic visualization, an absorbent cotton ball was positioned intranasally adjacent to the sphenopalatine foramen. CT was used to confirm correct placement and measured relevant anatomical distances. Tissue biopsies from the pterygopalatine fossa were collected via a transmaxillary surgical approach and analyzed using high-performance liquid chromatography-mass spectrometry.
resultsBupivacaine was detected in all pterygopalatine fossa biopsy samples except one, which was the farthest (17.5 mm) from the sphenopalatine foramen. Concentrations exceeded 1.00 µg/g in 29% and 0.10 µg/g in 71% of samples. The concentration decreased exponentially with distance from the application site, following a one-phase decay model (R²=0.74).
conclusionsThese findings demonstrate that bupivacaine can reach the pterygopalatine fossa from the nasal cavity when topically applied near the sphenopalatine foramen under endoscopic assistance, supporting the feasibility of such an approach. They also suggest the main mean of transport is simple diffusion, meaning that optimizing bupivacaine concentration, duration of application, and precise placement of the absorbent cotton ball are crucial for maximizing the block's clinical efficacy.
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