title: An unusual challenge in performing sphenopalatine ganglion block with enlarged coronoid process: Jacob's disease.
abstract: OBJECTIVE
  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 35 mm 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.
authors.affiliation: The Pain Center, Cedars Sinai Hospital, Los Angeles, California, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Zarembinski
authors.forename: Steven
authors.initials: S
authors.lastname: Graff-Radford
mesh_terms: D003027:Cluster Headache / Q000628:therapy*; D006801:Humans; D008297:Male; D008334:Mandible / Q000002:abnormalities*; D008875:Middle Aged; D059387:Sphenopalatine Ganglion Block
keywords: Cluster Headache; Elongated Coronoid Process; Jacob's Disease; Sphenopalatine Ganglion Block