Trigeminal (Gasserian) Ganglion, Maxillary Nerve, and Mandibular Nerve Blocks

2014 ◽  
pp. 53-57 ◽  
Author(s):  
Samer N. Narouze
Keyword(s):  
Mandibular Nerve ◽  
Gasserian Ganglion ◽  
Nerve Blocks ◽  
Maxillary Nerve

Endoscopic Endonasal Interdural Middle Fossa Approach to the Maxillary Nerve: Anatomic Considerations and Surgical Relevance

2017 ◽  
Vol 13 (4) ◽  
pp. 522-528 ◽  
Author(s):  
Kumar Abhinav ◽  
David Panczykowski ◽  
Wei-Hsin Wang ◽  
Carl H. Synderman ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Average Length ◽  
Tumor Resection ◽  
Human Head ◽  
Proximal Part ◽  
Gasserian Ganglion ◽  
Middle Fossa ◽  
Perineural Spread ◽  
Endoscopic Endonasal ◽  
Middle Fossa Approach ◽  
Maxillary Nerve

Abstract BACKGROUND: The maxillary nerve (V2) can be approached via the open middle fossa approach. OBJECTIVE: To delineate the anatomy of V2 and its specific segments with respect to the endonasal landmarks. We present the endoscopic endonasal interdural middle fossa approach to V2 and its potential application for the treatment of perineural spread in sinonasal/skull base tumors. METHODS: Five human head silicon-injected specimens underwent bilateral endoscopic endonasal transpterygoid approaches. V2 prominence and the maxillary strut were identified in the lateral recess along with paraclival carotid protruberance. The regions superior and inferior to V2 corresponding to the anteromedial and anterolateral triangles of the middle fossa were exposed. RESULTS: V2 can be classified into 3 segments: interdural (from the Gasserian ganglion to the proximal part of the maxillary strut), intracanalicular (corresponding to the anteroposterior length of the maxillary strut), and pterygopalatine (distal to the maxillary strut and the site of its divisions). Endonasally, the average length of the interdural and the intracanalicular segments were approximately 9 and 4.4 mm, respectively. V2, following its division distal to the maxillary strut, was successfully dissected off the middle fossa dura and transected just distal to the Gasserian ganglion. CONCLUSION: Endonasally, the interdural segment can be safely mobilized between the periosteal and meningeal dural layers while ensuring the integrity of the middle fossa dura. This allows transection of infiltrated V2 to facilitate tumor resection without entering the intradural/arachnoidal space. Posteriorly, this is limited by the Gasserian ganglion and superomedially by the dural envelope surrounding the cavernous sinus and the paraclival carotid artery.

Fluoroscopically guided mandibular nerve block: a modified lateral approach

2020 ◽  
Vol 45 (12) ◽  
pp. 1023-1025
Author(s):  
Jeffrey Jon Mojica ◽  
Vinay Kudur ◽  
Rudy Garza III ◽  
Maxim S Eckmann
Keyword(s):  
Nerve Block ◽  
Anterior Approach ◽  
Similar Efficacy ◽  
Lateral Approach ◽  
Mandibular Nerve ◽  
Anatomic Reconstruction ◽  
Nerve Blocks ◽  
Pterygoid Plate ◽  
Procedural Complications ◽  
Needle Trajectory

Background and objectivesMandibular nerve blocks are indicated for atypical face pain and trigeminal neuralgia. We hypothesized that a modified lateral approach, which entailed a combination of lateral and anterior approach techniques to the mandibular nerve block would lead to similar efficacy and improved safety profile rather than the typical lateral or anterior techniques.MethodsThis alternative approach was derived from anatomical investigation using the Radiology Anatomy Atlas Viewer and reconstructed axial cadaveric slices. We used axial slices at the level of the lateral pterygoid plate, and at the level of the temporomandibular joint to devise a needle path appropriate for this block.ResultsThe modified lateral approach to the mandibular nerve block was verified theoretically through cadaveric reconstructed slices and has been successfully performed in our practice. Precise needle trajectory could avoid both periosteal contact and gross redirection, as well as other procedural complications.ConclusionThe modified lateral approach to a mandibular nerve block avoids the respective risks associated with either the lateral and anterior approach. Facial intervention techniques typically pose increased safety challenges, however through cadaveric anatomic reconstruction, we have developed a safer approach for mandibular nerve blockade.

scholarly journals The Impact of Bilateral Suprazygomatic Maxillary Nerve Blocks on Postoperative Pain Control in Patients Undergoing Orthognathic Surgery

FACE ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 58-65
Author(s):  
Gabriela D. Garcia Nores ◽  
Daniel A. Cuzzone ◽  
Stefanie E. Hush ◽  
Kalyani Pandya ◽  
Adam Stuart ◽  
...  
Keyword(s):  
Pain Control ◽  
Complication Rates ◽  
Block Group ◽  
Nerve Blocks ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Nerve Blockade ◽  
Maxillary Nerve ◽  
Pain Scales ◽  
Le Fort I

Aims: The mainstay of analgesia in orthognathic interventions for maxillary hypoplasia is perioperative opioids, however, the side effect profile is broad with the potential for well-described deleterious effects. The suprazygomatic maxillary nerve block has been previously shown to be effective in decreasing pain associated with palatal surgery. To date, there have been no studies detailing the use of maxillary nerve blocks as an adjunctive pain control measure during correction of maxillary hypoplasia. Consequently, we sought to evaluate the efficacy of intra-operative, ultrasound-guided bilateral suprazygomatic maxillary nerve blockade in decreasing postoperative narcotic consumption in patients undergoing Le Fort I level surgical orthognathic correction of cleft-related maxillary hypoplasia. Methods: Between January and December 2019, patients underdoing suprazygomatic maxillary nerve blockade for orthognathic correction of maxillary hypoplasia via either Le Fort I advancement or distraction were prospectively collected and compared to controls. Patient demographics, narcotic use (represented as morphine milligram equivalents per kg; MME/kg), self-reported pain scales, operative times, length of stay (LOS), and complication rates were compared. Results: Over the 12-month interval, 40 patients met inclusion criteria (n = 19 Block; n = 21 Control). Mean ages were 15.6 and 15.9 years, respectively. The block group demonstrated a significant reduction in postoperative narcotic requirements on POD1 and POD2 when compared to controls (POD1: 0.020 mg/kg vs 0.066 mg/kg, P < .005; POD2: 0.030 mg/kg vs 0.080 mg/kg, P < .016), with a trend toward significance thereafter. Corroboratively, self-reported pain scores in the first 24 hours were significantly decreased in the block compared to control groups with a trend toward significance thereafter (POD1: 1.13 vs 2.72, P < .001; POD2: 1.72 vs 2.56, P < .08; POD3: 1.21 vs 2.07, P < .06). LOS was decreased by an average of 1 day in the block group, operative times were unchanged, and neither group evidenced perioperative complication or return to service within 30 days. Conclusion: Administration of bilateral suprazygomatic maxillary nerve blocks in patients undergoing Le Fort I maxillary osteotomy for correction of cleft-related maxillary deficiency demonstrated a significant reduction in post-operative narcotic requirements, self-reported pain scales, and LOS without increased complications, suggesting its utility as a safe and effective analgesic adjunct in this patient population.

Midsubtemporal Ridge as a Predictor of the Lateral Loop Formed by the Maxillary Nerve and Mandibular Nerve: A Cadaveric Morphological Study

2011 ◽  
Vol 69 (suppl_1) ◽  
pp. ons95-ons98 ◽  
Author(s):  
Masahiko Wanibuchi ◽  
Gen Murakami ◽  
Taro Yamashita ◽  
Yoshihiro Minamida ◽  
Takanori Fukushima ◽  
...  
Keyword(s):  
Early Stage ◽  
Morphological Characteristics ◽  
Cranial Base ◽  
Mandibular Nerve ◽  
Maxillary Nerve ◽  
Lateral Triangle ◽  
Adjacent Structures ◽  
Lateral Loop ◽  
Bony Ridge ◽  
Cranial Base Surgery

Abstract BACKGROUND: The lateral loop formed by the maxillary nerve (V2) and the mandibular nerve (V3) consists of a part of the far lateral triangle of the cavernous sinus. Because this triangle becomes a surgical corridor of the preauricular infratemporal fossa approach and a landmark of the extradural approach for the ganglion-type trigeminal schwannomas, identification of the lateral loop has important implications at the early stage of middle cranial base surgery. We realized that a bony ridge usually existed just lateral to the lateral loop. OBJECTIVE: To nominate midsubtemporal ridge (MSR) as the name for this anatomically unnamed bony ridge and to clarify its features. METHODS: Using 35 cadaver heads, we measured the shape of the MSR on both sides and the distance between the MSR and the adjacent structures. RESULTS: The MSR was recognized in 60 of 70 specimens (85.7%). The bony protrusion was 2.9 ± 1.1 mm in height, 6.0 ± 2.1 mm in width, and 9.1 ± 3.2 mm in length. A single peak with anteroposterior length was common in 47 of 60 specimens (78.3%). The MSR was located at the midpoint of the V2 and V3 in 28 specimens (46.7%) and existed 10.7 ± 3.6 mm lateral from the line that bound the foramen rotundum and the foramen ovale. CONCLUSION: We demonstrate morphological characteristics of the MSR. These data on the MSR will assist the surgeon in identifying the lateral loop as a surgical landmark during middle cranial base surgery.

USE OF A NERVE LOCATOR TO FACILITATE ADMINISTRATION OF MANDIBULAR NERVE BLOCKS IN CROCODILIANS

2006 ◽  
Vol 37 (3) ◽  
pp. 405-408 ◽  
Author(s):  
James F. X. Wellehan ◽  
Cornelia I. Gunkel ◽  
David Kledzik ◽  
Sheilah A. Robertson ◽  
Darryl J. Heard
Keyword(s):  
Mandibular Nerve ◽  
Nerve Blocks

scholarly journals Radiofrequency Thermocoagulation Through Foramen Rotundum Versus Foramen Ovale for the Treatment of V2 Trigeminal Neuralgia

2019 ◽  
Vol 6 (22;6) ◽  
pp. E609-E614
Author(s):  
Cong-yang Yan
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Operation Time ◽  
Controlled Clinical Trial ◽  
Gasserian Ganglion ◽  
Internal Opening ◽  
Foramen Ovale ◽  
Maxillary Nerve ◽  
Radiofrequency Thermocoagulation ◽  
Foramen Rotundum

Background: Percutaneous radiofrequency thermocoagulation through the foramen rotundum (FR) is a new approach for the treatment of V2 trigeminal neuralgia (TN). Objectives: This study aimed to compare the efficacy and safety of the FR approach with that of the foramen ovale (FO) approach. Study Design: Nonrandomized controlled clinical trial. Setting: The study was conducted at Huaian Hospital of Huaian City, Huaian, China. Methods: From July 2014 to December 2016, 80 consecutive patients with V2 TN were prospectively assigned into the FO group (n = 40) or the FR group (n = 40). All radiofrequency thermocoagulation procedures were performed under the guidance of digital subtraction angiography (DSA). Patients in the FO group were treated with Gasserian ganglion ablation through the Hartel approach. Patients in the FR group received ablation of the maxillary nerve at the internal opening of the FR. Facial pain was evaluated using the Visual Analog Scale preoperatively and postoperatively at 1 week, 6 months, and 1 year. Results: All surgical procedures were successfully completed using DSA guidance. The FR group had no facial pain at postoperative 1 week, 6 months, and 1 year. The facial fain was not relieved in 4 patients of the FO group. They were treated with radiofrequency thermocoagulation of the maxillary nerve through the FR and maintained painless at postoperative 1 week, 6 months, and 1 year. At postoperative 1 year, another 3 patients relapsed in the FO group. The incidences of facial numbness and swelling did not differ significantly between the 2 groups (all P > 0.05). There was no postoperative corneal involvement or masticatory weakness in the FR group. However, corneal involvement and masticatory weakness occurred postoperatively in 22 (55%) patients and 31 (77.5%) patients in the FO group. The FR group had significantly shorter operation time than the FO group (19.3 ± 5.9 vs. 32.7 ± 8.7 minutes; P < 0.05). Limitations: We were unable to avoid the V1 and V3 branches, despite multiple adjustments of the needed position in 35 of the 40 patients in this group. Conclusions: For the treatment of V2 TN, thermocoagulation of the maxillary nerve through the FR had better efficacy and fewer complications in comparison with the Gasserian ganglion ablation through the FO

Visualization of Dark Side of Skull Base with Surgical Navigation and Endoscopic Assistance: Extended Petrous Rhomboid and Rhomboid with Maxillary Nerve–Mandibular Nerve Vidian Corridor

2019 ◽  
Vol 129 ◽  
pp. e134-e145
Author(s):  
Kentaro Watanabe ◽  
Ali R. Zomorodi ◽  
Moujahed Labidi ◽  
Shunsuke Satoh ◽  
Sébastien Froelich ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Navigation ◽  
Mandibular Nerve ◽  
Dark Side ◽  
Maxillary Nerve ◽  
Endoscopic Assistance

scholarly journals Bilateral suprazygomatic maxillary nerve blocks vs. infraorbital and palatine nerve blocks in cleft lip and palate repair

2019 ◽  
Vol 36 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Gaston Echaniz ◽  
Marcos De Miguel ◽  
Glenn Merritt ◽  
Plinio Sierra ◽  
Pranjal Bora ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Nerve Blocks ◽  
Maxillary Nerve ◽  
Palate Repair
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