Abstract Rhabdomyosarcoma is an uncommon tumor but is the most frequent soft-tissue sarcoma in children. It is classified into four histological subtypes: embryonal, alveolar, pleomorphic, and spindle cell. The alveolar subtype, common in adolescents, has the worst prognosis. Treatment of craniofacial pain in children with cancer may benefit from blocking the trigeminal and sphenopalatine ganglia, which have shown efficacy in adults and potential in children. We present the case of a 14-year-old pediatric patient with metastatic sinonasal alveolar rhabdomyosarcoma and severe refractory hemifacial somatic and neuropathic pain despite initial multimodal analgesia. The patient underwent neurolysis of the gasserian and sphenopalatine ganglia guided by fluoroscopy, resulting in a significant reduction in pain from 7/10 to 2/10 on the Numeric Rating Scale for pain, with sustained favorable outcomes. These types of neurolytic blocks represent promising therapeutic options for managing oncological pain in children, although further research is needed to establish standardized protocols and assess long-term outcomes.