Abstract
Background
Pain control is an integral part of minor oral surgery and maxillary/mandibular nerve blocks have proved promising in achieving the same. Although intra oral techniques of maxillary nerve block are common and are widely used, there are certain inherent disadvantages and potential complications. Less commonly described in the literature, the extra oral techniques have a wide spectrum of indications as well as can be more advantageous than the intra oral approach. This prospective clinical trial is an attempt to evaluate the feasibility and the efficacy of the extra oral frontozygomatic approach to the foramen rotundum to block the maxillary nerve.
Materials and Methods
Sample size was 100 patients and the inclusion criteria were patients of ASA I or II category who needed extraction of a minimum of 4 maxillary teeth in the same quadrant in a single sitting while exclusion criteria were patients with a history of allergy to local anesthesia, medically compromised patients in whom dental extraction was contraindicated. Mean age was 71.9 years and 56 patients were males while 44 were females. Only a single quadrant (first or second) was chosen as the operative site in each patient and local anaesthesia was secured using a 21 gauge 89 mm long spinal needle with frontozygomatic angle approach and the parameters used were pain experienced during the injection, onset of subjective symptoms, time required for the peak effect (objective symptoms), pain during extraction and the duration of anesthesia. All the parameters were expressed as mean values with standard deviations.
Results
A successful anesthesia was secured in first attempt in 98 patients while in 2 patients, the procedure had to be repeated owing to the difficulty in reaching the target site. A majority of the patients i.e., 71 % scored 0–2 (no pain) on visual analogue scale (VAS) while only 2 patients experienced a moderate degree of pain. Subjective symptoms were reported in 27.24 s (mean value) and 12.93 s (mean value) in the palate and the infraorbital fossa respectively. Peak effect of anesthesia was noted in 66.7, 37.38 and 31.71 s (all values expressed as mean) in palate, infraorbital fossa and posterior superior alveolar areas respectively.
Conclusion
Although with only dental extraction as the procedure of choice, the present study has favoured the frontozygomatic angle approach for the maxillary nerve block as simple, safe, efficacious and associated with minimum and clinically mild complications.
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References
Padhye M, Gupta S, Chandiramani G, Bali R (2011) PSA block for maxillary molar’s anesthesia–an obsolete technique? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:e39–e43
Stajcic Z, Todorovic Lj (1997) Blocks of the foramen rotundum and the oval foramen: a reappraisal of extraoral maxillary and mandibular nerve injections. Br J Oral Maxillofac Surg 35:328–333
Captier G, Dadure C, Leboucq N, Sagintaah M (2009) Anatomic study using three-dimensional computed tomographic scan measurement for truncal maxillary nerve blocks via the suprazygomatic route in infants. J Craniofac Surg 20:224–228
Moiseiwitsch J, Irvine T, Hill C (2001) Clinical significance of the length of the pterygopalatine fissure in dental anesthesia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 92:325–328
Poore TE, Carney FMT (1973) Maxillary nerve block: a useful technique. J Oral Surg 31:749–755
Broering R, Reader A, Beck M, Meyers W (1991) Evaluation of second division nerve blocks in human maxillary anesthesia (abstract). J Endod 17:194
Walton RE, Reader A (1996) Local anesthesia. In: Walton RE, Torabinejad M (eds) Principles and practice of endodontics, 2nd edn. WB Saunders Co, Philadelphia, p 105
Loetscher C, Melton DC, Walton RE (1988) Injection regimen for anesthesia of the maxillary first molar. J Am Dent Assoc 117:337–340
Mesnil M, Dadure C, Captier G, Raux O, Rochette A, Canaud N, Sauter M, Capdevila X (2010) A new approach for per-operative analgesia of cleft palate repair in infants: the bilateral suprazygomatic maxillary nerve block. Pediatr Anesth 20:343–349
Sola C, Raux O, Savanth L, Macq C, Capdevila X, Dadure C Ultrasound guidance characteristics and efficiency of suprazygomatic maxillary nerve blocks in infants: a descriptive prospective study. Pediatr Anesth ISSN 1155–5645
Neill RS (1995) Head and neck. In: Nimmo WS, Rowbothan DJ, Smith G (eds) Anaesthesia vol 2, 2nd edn. Blackwell Scientific Publications, Oxford, pp 1524–1536
Stajcic LS, Gacic B, Popovic N, Stajcic Z (2010) Anatomical study of the pterygopalatine fossa pertinent to the maxillary nerve block at the foramen rotundum. Int J Oral Maxillofac Surg 39:493–496
Priman J, Etter LE (1961) Significance of variations of the skull in blocking the maxillary nerve—an anatomical and radiological study. Anesthesiology 22:42–48
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Radder, K., Shah, A., Fatima, S. et al. Efficacy and Feasibility of Frontozygomatic Angle Approach for Extra Oral Maxillary Nerve Block in Oral Surgery: A Descriptive Clinical Trial. J. Maxillofac. Oral Surg. 13, 231–237 (2014). https://doi.org/10.1007/s12663-013-0514-7
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DOI: https://doi.org/10.1007/s12663-013-0514-7