Neurolysis of the Sphenopalatine Ganglion for Refractory Facial Pain in a Paediatric Cancer Patient: A Case Report

Facial pain associated with oncologic pathologies in pediatric patients presents significant diagnostic and therapeutic challenges with a considerable impact on quality of life. In this context, chemical neurolysis of the sphenopalatine ganglion emerges as a promising therapeutic option. We present the case of a 9-year-old girl with embryonal rhabdomyosarcoma who experienced severe facial pain resistant to conventional treatment. The pain was described as continuous, disabling, and neuropathic in nature, affecting basic functions such as eating and sleeping. Pharmacological management with opioids and adjuvants was insufficient, with high opioid requirements and minimal relief. A diagnostic sphenopalatine ganglion block was performed using a transnasal approach, yielding temporary but complete analgesia. Based on this response, percutaneous chemical neurolysis via the infrazygomatic route was carried out under fluoroscopic guidance using absolute alcohol. Following the intervention, pain intensity decreased from 10/10 to 4/10 at 24 hours and to 0/10 at 7 days, with sustained complete pain relief at 3-month follow-up. This was accompanied by a substantial improvement in quality of life and complete discontinuation of opioid use. No complications were observed during or after the procedure. This case highlights the efficacy and safety of chemical neurolysis of the sphenopalatine ganglion as an innovative therapeutic option for refractory facial pain in pediatric patients with head and neck oncologic diseases, particularly when conventional measures fail.