Patient-administered sphenopalatine ganglion block.

BACKGROUND AND OBJECTIVES: Pain resulting from head and neck cancer can be severe and difficult to manage. Avoiding hospitalization for as long as possible with a reasonable level of comfort requires a number of therapeutic modalities. The usefulness of self-administered sphenopalatine ganglion block was evaluated in a patient with lethal midline granuloma requiring large doses of morphine. METHODS: A 30-year-old woman with intractable pain from lethal midline granuloma was taught to self-administer 4% lidocaine, 1.5 mL topically into each nostril three times per day. RESULTS: A 3-month follow-up examination showed substantial pain relief and reduction in morphine requirement. No adverse side effects or complications developed. CONCLUSIONS: In certain patients, sphenopalatine ganglion block can be effectively self-administered at home to manage chronic pain.

[Mediofacial necrosis and malignant centrofacial granuloma. Apropos of 8 cases and 1 with atypical localizations]. / Nécroses médio-faciales et granulome malin centro-facial. A propos de 8 cas et d'une localisation atypique.

Since the first descriptions by McBride and then Stewart, and later reports by wegener, numerous publications have contained data emphasizing the diagnostic and classification difficulties of these affections, 450 cases having been documented up to the present times. Findings clearly demonstrate that mediofacial necrosis differs greatly by its pathological, etiopathogenic and out come features, and particularly the localization of the lesions. Eight case were investigated, and conclusions drawn that it was important to identify the different affections grouped under the term "mediofacial necrosis", in order to isolate cases of pure malignant centrofacial granuloma, which have no detectable etiology and cannot be integrated in another nosological framework.

Wegener's granulomatosis and midline (nonhealing) "granuloma".

There has been considerable controversy over the years regarding the distinctions between various disorders characterized by a necrotizing and granulomatous inflammation of the tissues of the upper respiratory tract and oral cavity. It now seems clear that if infections and other known agents can be excluded, three clinicopathologic entities remain: Wegener's granulomatosis (a systemic disease), idiopathic midline (nonhealing) granuloma, and premalignant or malignant lymphoreticular lesions. The antigenic stimulus for all three may be related but remains unidentified.