Background and Aims Sphenopalatine ganglion (SPG) is situated in the posterior nasal cavity and belongs to the cranial part of the autonomic nervous system. Trigeminal neuralgia (TGN) is currently considered as an indication for SPG block, especially in medication-resistant cases. The aim of this study was to assess the effectiveness of the SPG block for the treatment of trigeminal neuralgia, using a noninvasive transnasal approach, by delivering local anesthetic with the alternative device Tx360 nasal applicator.

Methods Four patients (three women, aged 67, 56 and 75 and a man, aged 58) presented with either classical or atypical, V2 (maxillary branch) or V3 (mandibular branch) TGN, partly or completely drug-resistant. Pain severity during paroxysmal attacks was recorded using the visual analogue scale and it scored between 8 and 9 for all patients. The SPG block was achieved using the Tx360 nasal applicator in order to deliver 0.3 ml of xylocaine 2%, once a week, for 6 to 8 weeks. Participants in this study received up to 8 SPG blocks.

Results All patients reported significant pain relief and were completely symptom-free after the 2^nd or 3^rd application. This favorable outcome lasted for up to 3 months for each case. No significant adverse events were noted.

Conclusions Data extracted from this pilot study suggest that repetitive SPG block with the Tx360 nasal applicator may constitute an easy, rapid, safe and efficient treatment of trigeminal neuralgia. Further relative double-blind, randomized studies are required in order to draw solid conclusions.