Morphometric study of incisive, greater and lesser palatine foramina: a novel point of maxillary nerve block in a Thai population / Estudio morfométrico del foramen palatino incisivo, mayor y menor: un punto novedoso de bloqueo del nervio maxilar en una población tailandesa

SUMMARY: To study the morphometric location of the incisive, greater, and lesser palatine foramina for maxillary nerve block. Two hundred Thai dry skulls were randomly organized from the Forensic Osteology Research Center. The distances of the parameters were measured via Vernier caliper.: Thedistances from the incisive foramen to the incisive margin of the premaxilla were 10.93?2.42 mm in males and 10.98?2.06 mm in females. From the left side, the incisive foramen to the greater palatine foramen (GPF) was39.07?2.23mm in males and 38.57?2.41 mm in females, and from the right side were 39.81?2.37 mm in males and 38.62?2.53mm in females. From the left side, the incisive foramen to the lesser palatine foramen (LPF) was 43.16?2.23 mm in males and 41.84?2.42mm in females and from the right side were 42.93?2.14 mm in males and 41.76?2.61 mm in females. The GPF found at medial to the maxillary third molar were 94-95 % in males and 84 % in females. These findings suggest that the medial position to the third molar teeth be used as a landmark for a palatine nerve block in Thais. These findings will help dentists to perform local anesthetic procedures, especially the nasopalatine and greater palatine nerve blocks, more effectively.

RESUMEN: El objetivo de este trabajo fue estudiar la localización morfométrica de los forámenes palatinos incisivos, mayores y menores para el bloqueo del nervio maxilar. Se organizaron al azar doscientos cráneos secos tailandeses del Centro de Investigación de Osteología Forense. Las distancias de los parámetros se midieron mediante un calibre Vernier. Las distancias desde el foramen incisivo hasta el margen incisivo de la premaxila fueron 10,93 ? 2,42 mm en hombres y 10,98 ? 2,06 mm en mujeres. Desde el lado izquierdo, el foramen incisivo al foramen palatino mayor (FPM) fue de 39,07 ? 2,23 mm en los hombres y 38,57 ? 2,41 mm en las mujeres, y del lado derecho fue de 39,81 ? 2,37 mm en los hombres y 38,62 ? 2,53 mm en las mujeres. Del lado izquierdo, el foramen incisivo al foramen palatino menor (LPF) fue de 43,16 ? 2,23 mm en hombres y 41,84 ? 2,42 mm en mujeres y del lado derecho 42,93 ? 2,14 mm en hombres y 41,76 ? 2,61 mm en mujeres. El FPM encontrado medial al tercer molar maxilar fue 94-95 % en hombres y 84 % en mujeres. Estos hallazgos sugieren que la posición medial de los terceros molares se utilice como punto de referencia para un bloqueo del nervio palatino en individuos tailandeses. Estos hallazgos ayudarán, de manera más eficaz, a los dentistas a realizar procedimientos anestésicos locales, especialmente los bloqueos nasopalatinos y del nervio palatino mayor.

Frequency of canalis sinuosus and its anatomic variations in cone beam computed tomography images / Frecuencia de canalis sinuosus y sus variaciones anatómicas en imágenes de tomografía computarizada de haz cónico

The aim of this paper was to determine the frequency of Canalis Sinuosus (CS) and its anatomic variations. A total of 236 cone beam computed tomography (CBCT) images were studied. Characteristics of the canal such as its form, pathway and diameter were analyzed. The CS was clearly visualized in 100 % of the images with variations in the canal observed in up to 46 % of the cases. In 79 % of the cases the variation was found to be bilateral. The most common variation was an increase in the diameter (> 1mm) of the CS. Considering that the anterior region of the middle third of the face is a common place for clinical interventions, this study supports the need to perform a thorough evaluation of the maxillary region prior to clinical interventions in order to prevent complications such as direct or indirect injury to the anterior superior alveolar neurovascular bundle contained within the CS.

El objetivo de este trabajo fue determinar la frecuencia de Canalis Sinuosus (CS) y sus variaciones anatómicas. Se estudiaron un total de 236 imágenes de tomografía computarizada de haz cónico (CBCT). Se analizaron las características del canal, como su forma, vía y diámetro. El CS se visualizó claramente en el 100 % de las imágenes, observándose variaciones en el canal en hasta el 46 % de los casos. En el 79 % de los casos la variación fue bilateral. La variación más común fue un aumento en el diámetro (> 1 mm) de la CS. Teniendo en cuenta que la región anterior del tercio medio de la cara es un lugar común para las intervenciones clínicas, este estudio apoya la necesidad de realizar una evaluación exhaustiva de la región maxilar antes de las intervenciones clínicas para prevenir complicaciones como lesiones directas o indirectas a el haz neurovascular alveolar superior anterior contenido dentro de la CS.

Endoscopic anatomy of infraorbital/maxillary nerves in endoscopic transmaxillary approach / 中国神经精神疾病杂志

Objective To explore the localization and guidance value of infraorbital/maxillary nerve in endoscopic transmaxillary approach, and to provide anatomical data for clinical operation. Methods The eight adult cadaver heads were dissected by means of the endoscopic transmaxillary approach to expose the infraorbital/maxillary nerve, and relevant data were collected. Results In 8 cases, 16 maxillary nerves arose from the trigeminal ganglion of the trigeminal nerve and emerged from the foramen rotundum, transited to the infraorbital nerve at the infraorbital fissure, then traveled in the infraorbital canal and out of the infraorbital foramen. The infraorbital/maxillary nerve could be divided into four segments according to the foramen rotundum, infraorbital groove and infraorbital foramen: the terminal segment, the infraorbital nerve and its terminal branches to the face, distal to the infraorbital foramen; the orbitomaxillary segment and the orbitomaxillary segment of the infraorbital nerve within the infraorbital canal from the infraorbital foramen along the infraorbital groove (length 11.7 ±2.5 mm ), which was readily identified in the roof of the maxillary sinus in all specimens. The pterygopalatine segment, the pterygopalatine segment within the pterygopalatine fossa, which started at the infraorbital groove to the foramen rotundum (length 13.4±2.1 mm); The intracranial segment, the intracranial segment from the foramen rotundum to the trigeminal ganglion(length 15.2±3.9 mm). Conclusion The infraorbital nerve can serve as a anatomical landmark for endoscopic transmaxillary approach to get access to infratemporal fossa, pterygopalatine fossa, trigeminal ganglion and lateral wall of the cavernous sinus.

Morphological and morphometric characterization of the "sphenoidal tubercle" / Caracterización morfológica y morfométrica del tubérculo esfenoidal

The sphenoidal tubercle is a bone elevation located in the anterior edge of the infratemporal crest of the sphenoid greater wing, where the temporal and lateral pterygoid muscles have their origin. This bone accident presents varied morphology so its description and denomination are a topic of discussion. 60 dry skulls obtained from the morphology laboratory of the Biomedical Basic Sciences Department of the University of Talca were used for a morphological and morphometric analysis of the sphenoidal tubercle including its morphology, diameters (anteroposterior, transverse and vertical) and the distance to the grooves for the maxillary artery and maxillary nerve. Sphenoidal tubercle had a prevalence of 98.4 % of all dry skulls analyzed with a bilateral presentation in the 76.6 % of the cases. According to its different forms of presentation established by Cáceres et al., (2016) the pyramidal form was the most frequent with a 25.7 %. The average diameters were of 4.12 mm anteroposterior, 5.50 mm transverse and 3.89 mm vertical. The average distance to the grooves of the maxillary artery and maxillary nerve were 9.04 mm and 7.6 mm, respectively. Sphenoidal tubercle is a constant bone accident with a variated morphology and measures. Due to its anatomical relations with important neurovascular elements such as the maxillary artery and the maxillary nerve, it may be used as a reference point for surgical access to the infratemporal fossa. From this analysis we establish that the denomination of "infratemporal process" is more accurate, because the development of this bone accident is from muscular traction performed by the lateral pterygoid muscle and the deep portion of the temporal muscle causing great variations in its morphology, probably due to external and functional parameters or even influenced by the biotype.

El tubérculo esfenoidal es una elevación ósea ubicada en el extremo anterior de la cresta infratemporal del ala mayor del hueso esfenoides, donde presta inserción al músculo temporal y pterigoideo lateral. Presenta morfología variada, por lo que su descripción y denominación resultan motivo de discusión. 60 cráneos secos obtenidos del Laboratorio de Morfología del Departamento de Ciencias Básicas Biomédicas de la Universidad de Talca, fueron utilizados para realizar un análisis morfológico y morfométrico del tubérculo esfenoidal evaluando forma, diámetros (anteroposterior, laterolateral y vertical) y distancia con el surco de la arteria y nervio maxilar. El tubérculo esfenoidal tuvo una prevalencia del 98,4 % del total de cráneos analizados, presentándose bilateralmente en el 76,6 % de los casos. De acuerdo a las diferentes formas de presentación establecidas por Cáceres et al (2016) la forma piramidal fue la más frecuente con un 25,7 %. Los diámetros promedio fueron de 4,12 mm anteroposterior, 5,50 mm laterolateral y 3,89 mm vertical. Las distancias promedio con el surco de la arteria y nervio maxilar fueron de 9,04 mm y 7,6mm, respectivamente. El tubérculo esfenoidal es un accidente óseo constante de morfología y dimensiones variadas. Debido a sus relaciones con elementos vasculares de importancia, tales como la arteria y nervio maxilar, podría ser utilizado como elemento de referencia para el acceso quirúrgico a la fosa infratemporal. A partir de su análisis planteamos que su denominación como "proceso infratemporal" sería más apropiado, debido a que se desarrollaría a partir de la tracción muscular ejercida por el musculo pterigoideo lateral y la porción profunda del músculo temporal, ocasionando variaciones notables en su morfología, probablemente debido a factores externos y funcionales o incluso influenciada por el biotipo.

Subzygomatic and infraorbital approaches for maxillary nerve blockade in cats' cadaver / Abordagens subzigomática e infraorbitária para o bloqueio do nervo maxilar em cadáver de gatos

ABSTRACT: This study compared the accuracy of dye placement on the maxillary nerve by using the percutaneous subzigomatic (SBZ) and infraorbitary (IO) approaches in cats' cadavers. A second aim was to compare the accuracy of dye placement on the maxillary nerve between different untrained anesthetists. This was a prospective, randomized, blinded study, performed in 40 heads obtained from feline cadavers. Three veterinarians (A, B and C) with no previous experience with the IO approach performed the experiments. The SBZ approach was randomly performed on one side of the head and the IO approach was performed in the contralateral side of the same head. For each approach, 0.2ml of 1% methylene blue dye was injected. Scores for length of nerve staining were as follows: 0 (failure), no staining; 1 (moderate), <6mm of nerve stained; and 2 (ideal), ≥6mm of nerve stained. Median scores (interquartile range) for the SBZ and IO approaches were 2.0 (0.3-2.0) and 1.0 (0.0-2.0), respectively. Scores for length of nerve staining were higher with the SBZ approach than the IO approach (P=0.016). Considering the scores for both the SBZ and IO approaches, there was a significant difference among the three veterinarians (P=0.002). Results of this study do not support the IO approach to perform a maxillary nerve block in cats. A greater accuracy of methylene blue dye placement was observed with the SBZ approach. A variable accuracy may exist between different veterinarians when performing a maxillary nerve block employing the SBZ and IO techniques in cats.

RESUMO: O objetivo deste estudo foi comparar o acesso do nervo maxilar pela abordagem subzigomática (SBZ) com a abordagem pelo forame infraorbitário (IO) em peças anatômicas de gatos utilizando o corante azul de metileno. Um segundo objetivo foi comparar a acurácia na coloração do nervo maxilar com o azul de metileno entre diferentes anestesistas que não receberam treinamento prévio. Este estudo foi prospectivo, randomizado, cego, realizado em 40 peças anatômicas de cabeças de gatos. Três veterinários (A, B e C), sem experiência prévia da abordagem IO, realizaram o experimento. A abordagem SBZ foi aleatoriamente realizada em um dos lados da cabeça e a abordagem IO foi realizada no lado contralateral da mesma peça anatômica. Para cada abordagem, utilizou-se 0,2mL do corante azul de metileno 1%. Classificou-se o escore de coloração baseado no comprimento do nervo maxilar corado pelo azul de metileno conforme a escala: 0 (falha da técnica), sem coloração; 1 (moderado), <6mm de coloração do nervo maxilar; 2 (ideal), ≥6mm de coloração do nervo maxilar. As medianas (intervalo interquartil) para as abordagens SBZ e IO (dados de todos os veterinários juntos) foram respectivamente 2,0 (0,3-2,0) e 1,0 (0,0-2,0). A abordagem SBZ foi associada a um escore de coloração, significativamente, maior do que a abordagem IO (P=0,016). Considerando os escores de ambas abordagens (SBZ e IO), houve diferença significativa nos escores de coloração do nervo maxilar entre os três veterinários anestesistas (P=0,002). Os resultados deste estudo não sustentam a utilização da abordagem IO para a realização do bloqueio maxilar em gatos. Uma melhor acurácia na coloração do nervo maxilar com o azul de metileno foi observada com a abordagem SBZ. A acurácia da técnica pode variar quando as abordagens SBZ e IO são realizadas por veterinários diferentes, com o objetivo de se obter o bloqueio do nervo maxilar.

Comparative study of levobupivacaine and bupivacaine for bilateral maxillary nerve block during pediatric primary cleft palate surgery: a randomized double-blind controlled study / 대한마취과학회지

BACKGROUND: Cleft lip and palate are common major congenital anomalies. Cleft palate (CP) repair causes pain and needs large doses of intravenous opioids. The risk of postoperative airway obstruction or respiratory depression is high, requiring continuous and vigilant monitoring. The primary outcome was to evaluate the efficacy of using different local anesthetics during bilateral maxillary nerve block (MNB) with general anesthesia on quality of recovery after primary CP repair. We hypothesized that levobupivacaine would be better than bupivacaine. Also, to investigate the potency of bilateral MNB in improving quality of postoperative analgesia. METHODS: Sixty children undergoing primary CP repair surgery were enrolled in the study. Combined general anesthesia and regional bilateral MNB were used for all patients. Group L (n = 30): children received 0.15 ml/kg of 0.2% levobupivacaine, while in Group B (n = 30): children received 0.15 ml/kg of 0.2% bupivacaine. RESULTS: Face, Legs, Activity, Cry, and Consolability pain score readings were 0 score in 7 cases of the Group L and 10 cases of Group B, 1 score in 14 cases of the Group L and 12 cases of Group B, and 2 score in 9 cases of the Group L and 8 cases of Group B. We found no statistically significant difference between the two study groups as regarding pain score or serious complications. CONCLUSIONS: Levobupivacaine is as effective and safe as bupivacaine to be used for MNB block with a lower incidence of complications. Bilateral suprazygomatic MNB is an effective, easy, and safe method for pain relief in children undergoing primary cleft palate repair surgeries.

Avaliação de sensibilidade objetiva versus sensibilidade subjetiva após fraturas de zigoma / Sensitivity assessment objective versus objective after fracture of zygoma

Introdução: Cirurgiões bucomaxilofaciais frequentemente tratam fraturas do complexo zigomaticofacial e, com isso, os sinais e sintomas auxiliam o profissional a estabelecer o diagnóstico e a conduta frente a cada caso. A presença de alteração de sensibilidade é um sintoma frequente neste tipo de trauma. Objetivo: Avaliar comparativamente a presença e as alterações de sensibilidade subjetiva e sensibilidade objetiva após fraturas de zigoma. Metodologia: Foram selecionados 14 pacientes com fraturas unilaterais de zigoma. A sensibilidade subjetiva foi avaliada por meio de um questionário e a sensibilidade objetiva, mensurada por meio do monofilamento de Semmes-Weinstein. Resultado: Os resultados mostraram alteração de sensibilidade em 13 pacientes (92,84%); destes, oito pacientes (57,13%) apresentaram alterações de ordem subjetiva e dez (71,42%), de ordem objetiva. Alterações concomitantes de sensibilidade subjetiva e sensibilidade objetiva foram encontradas em cinco pacientes (35,71%). Afetados exclusivamente por um tipo de alteração de sensibilidade somaram oito pacientes (57,13%); destes, cinco pacientes (35,71%) apresentaram somente alterações objetivas e três pacientes (21,42%), apenas alterações subjetivas. A única queixa de sensibilidade subjetiva encontrada foi a hipoestesia, com sete casos (50%). Conclusão: As alterações de sensibilidade são frequentemente encontradas após fraturas de zigoma, existindo uma forte correlação entre a perda da percepção subjetiva e a perda da sensibilidade objetiva; porém, ocorre predominância de alterações de ordem objetiva.

Introduction: Maxillofacial surgeons often treat zygomatic facial complex fractures, therefore, signs and symptoms of these fractures help establish the diagnosis and the procedure for every case. The presence of sensibility alteration is a common symptom in this type of trauma. Objective: This study evaluated comparatively the presence and changes of subjective and objective sensitivity after zygomatic fractures. Methodology: Fourteen patients were selected with unilateral fractures of zygomatic. Subjective sensitivity was evaluated through a questionnaire and objective sensitivity measured by the Semmes-Weinstein monofilament. Result: The results shows sensibility alteration was found in 13 patients (92.84%), of these, 8 patients (57.13%) had changes of subjective order and 10 (71.42%) of objective order. Concomitant changes in subjective and objective sensitivity were found in 5 patients (35.71%). Patients affected only by one type of sensibility alteration totaled 8 patients (57.13%); of these, 5 patients (35.71%) had only objective alterations and 3 patients (21.42%) only subjective sensitivity alterations. The only complaint of subjective sensitivity was hypoesthesia in 7 cases (50%). Conclusion: The sensitivity changes are often found after zygomatic fractures there is a strong correlation between the loss of subjective perception and objective, however, especially the changes in the objective order.

Vertiginous syndrome associated with incorrect anesthesia technique to block the maxillary nerve via the greater palatine canal: case report and anatomic correlation with cadaveric parts / Síndrome vertiginoso asociado a técnica anestésica incorrecta para bloquear el nervio maxilar vía canal palatino mayor: reporte de caso y correlación anatómica en piezas cadavéricas

The anesthetic technique through the greater palatine canal seeks to block the maxillary nerve in the pterygopalatine fossa and anesthetize a large area, including the pulp and periodontium of the arch in question. After applying this technique in a patient, it failed to obtain the expected result. The patient began to experience dizziness, nausea, vomiting and the sensation of fluid in the ear. She was evaluated in both the emergency room of the Hospital Parroquial de San Bernardo and at a private clinic without accurate diagnosis. Only symptomatic treatment was provided. The next day she was discharged with reduced symptoms, which disappeared completely during the day. We propose the hypothesis of a diffusion of the anesthetic solution into the middle and inner ear through the auditory tube. This diffusion would explain the vestibular symptoms and the absence of anesthesia in the expected areas. We carried out an anatomic correlation in cadavers, following the path of a needle from the palatal mucosa to the pharyngeal opening of auditory tube. We conclude that the vertiginous syndrome could be due to an incorrect application of the technique, with the needle entering the auditory tube and spreading the anesthetic solution into the middle ear.

La técnica anestésica vía canal palatino mayor tiene como objetivo abordar al nervio maxilar en la fosa pterigopalatina, anestesiando un gran territorio, incluyendo la pulpa y periodonto de la hemiarcada correspondiente. Después de haber aplicado esta técnica en una paciente y no obteniendo el resultado esperado, esta comenzó a experimentar vértigo, náuseas, sensación de líquido en el oído y vómitos. Fue evaluada en el servicio de urgencias del Hospital Parroquial de San Bernardo y en una Clínica Privada, sin lograr un diagnóstico preciso y realizando solo un tratamiento sintomático. Al día siguiente fue dada de alta con baja sintomatología, la cual desapareció totalmente durante el día. Se propone la hipótesis de una difusión del anestésico hacia el oído medio e interno mediante el tubo auditivo. Esto explicaría por un lado la sintomatología vestibular y por otro la ausencia de anestesia en los dientes y territorios esperados. Además se realizó una correlación anatómica en cadáveres, utilizando 8 hemicabezas conservadas y siguiendo el posible trayecto de la aguja desde la mucosa palatina hasta el orificio faríngeo de la tuba auditiva. Se concluyó que el síndrome vertiginoso experimentado por la paciente se pudo deber a una técnica fallida al nervio maxilar vía canal palatino mayor con ingreso de la aguja al tubo auditivo, difundiendo el anestésico hacia el oído medio.

Relationship between volume of pterygopalatine fossa and block anesthesia of maxillary nerve: a pilot study / Relación entre el volumen de la fosa pterigopalatina y la anestesia troncular del nervio maxilar: un estudio piloto

Block anesthesia of maxillary nerve 9BAMN) is achieved by depositing anesthesia through greater palatine canal into the pterygopalatine fossa. Authors differ in the amount of anesthesia to be administered and the rate of complications (diplopia and hematomas), Coronado et al., (2008), measured the size of the pterygopalatine fossa finding an average of 1.2 ml, suggesting that amount of anesthesia for BAMN. The aim of this study is to compare the effectiveness of low doses of 1.2 ml (LD)versus traditional dose of 1.8 m. (TD) of anesthesia for BAMN and its adverse effects. A quasi experimental exploratory clinical study was performed involving 82 patients where the anesthetic technique was suitable for tooth extraction procedure; patients were randomized in LD and TD groups, 2 percent lidocaine with 1:50.000 epinephrine was used. Demographic (sex and age), clinical (tooth for extraction and anesthetic dose) as well as anatomical variables (upper facial and cranial index) were recorded. The anesthetic success (AS) was defined as the possibility to perform the tooth extraction with no pain or minimal pain as measured by visual analogue scale (VAS). For statistical analysis chi-square and t test (p <0.05) were used. The results show that the pain and AS were 2.93 and 61.67 percent in LD group and 3.09 and 59.09 percent in TD group respectively, there were 6 cases of diplopia with no significant statistical difference between groups.

El bloqueo troncular del nervio maxilar (BTNM) se logra depositando anestesia vía canal palatino mayor en la fosa pterigopalatina. Los autores difieren en la cantidad de anestesia a depositar y la tasa de complicaciones asociadas (diplopía y hematomas). Coronado et al. (2008) midió el volumen de la fosa pterigopalatina encontrando un promedio de 1,2ml, sugiriendo dicha cantidad de anestesia para el BTNM. El objetivo del presente trabajo es comparar la eficacia de dosis bajas de 1,2ml (DB) versus dosis tradicional de 1,8ml (DT) de anestesia para el BTNM y sus efectos adversos. Se realizó un estudio clínico cuasiexperimental de carácter exploratorio, participaron 82 pacientes donde la técnica anestésica estaba indicada para un procedimiento de exodoncia, los que fueron aleatorizados en los grupos DB y DT, administrándoles lidocaína al 2 por ciento con 1:50.000 de epinefrina. Se registraron variables demográficas (sexo y edad), clínicas (pieza a extraer y dosis administrada) y anatómicas (índices facial superior y craneal). El éxito anestésico (EA) se definió como la posibilidad de realizar la exodoncia con nulo o mínimo dolor, medido con escala visual análoga (EVA). En el análisis estadístico se utilizaron los tests de chi cuadrado y t de student (p<0,05). Los resultados muestran que el dolor y el EA en el grupo DB fueron de 2,93 y 61,67 por ciento y en el DT de 3,09 y 59,09 por ciento respectivamente, hubo 6 casos de diplopía sin diferencias estadísticamente significativas entre ambos grupos.

Estudo da difusão da articaína na polpa de dentes maxilares e no palato / Study of articaine diffusion into the pulp of maxillary teeth and to the palate

Objective: The purpose of this study was to assess if 4% articaine with 1:100,000 epinephrine (DFL®, Rio de Janeiro, Brazil) provides the necessary diffusion to anesthetize dental pulps innervated by the anterior and medium branches of the superior alveolar nerve as well as the nasopalatine region after posterior superior alveolar nerve block. Methods: In this descriptive and quantitative study, selected total of 30 patients was selected, with healthy superior-lateral incisors and first premolars, who were submitted to cold testing of the pulp, puncture of the nasopalatine region and identification of the stimuli on the visual analogue Faces Pain Scale. This procedure was repeated in two stages, four minutes and eight minutes after the posterior superior alveolar nerve block with articaine.Results: Eight minutes after the injection, 50% of patients reported complete absence of pain (score zero) in the lateral incisor tested, 80% in the premolar and 36.67% in the nasopalatine region. No statistically significant diffusion was recorded in either gender (p = 0.26) or between different age groups (p=0.29). Conclusion: Diffusion did not occur with the expected intensity in all patients, which does not exclude the use of anesthetic block on these nerves when an intervention is needed in the region.

Objetivo: Avaliar se a articaína a 4% com epinefrina 1:100.000 (DFL®, Rio de Janeiro, Brazil) apresenta uma difusão capaz de insensibilizar as polpas dentárias inervadas pelos ramos médio e anterior do nervo alveolar superior e insensibilizar, também, a região nasopalatina, quando utilizado o bloqueio anestésico do nervo alveolar superior posterior.Métodos: Neste estudo descritivo e quantitativo, foram selecionados 30 pacientes com incisivo lateral superior e primeiro pré-molar superior hígidos, os quais foram submetidos a teste pulpar a frio e punção na região nasopalatina e identificação dos estímulos na Escala de Faces de Dor. Este procedimento foi repetido em duas etapas: com quatro minutos e oito minutos após o bloqueio do nervo alveolar superior posterior com articaína. Resultados: Em seguida aos testes de sensibilidade, verificou-se que após oito minutos da anestesia por bloqueio, 50.00% dos pacientes referiram ausência de dor (escore zero) no incisivo lateral testado, 80.00% no pré-molar e 36,67% na região nasopalatina. Não foi registrada difusão estatisticamente significante em relação aos sexos (p = 0,26) e entre as faixas etárias analisadas (p = 0,29). Conclusão: Esta difusão não ocorreu em todos os pacientes com a intensidade esperada, o que não descarta o uso do bloqueio destes nervos quando houver necessidade de intervenção na região.

Biplane Fluoroscopy Guided Maxillary Nerve Block and Pulsed Radiofrequency Lesioning of the Mandibular Nerve: A report of two cases / 대한통증학회지

Biplane fluoroscopy is usually used in angiography. Biplane fluoroscopy gives a biplane image with high resolution during the performance of operations. Trigeminal nerve blocks are effective treatment modalities for trigeminal neuralgia, and maxillary nerve block is the most dangerous procedure among them. The anatomic structures can change after head and neck surgery, so the trigeminal nerve block procedures cannot be done so easily. We used biplane fluoroscopy in these difficult cases. Our first case was a 60-year-old man who had undergone maxillary nerve block. The second case was of a 64-year-old man who had pulsed radiofrequency lesioning of mandibular nerve performed after head and neck surgery. With biplane fluoroscopy, we got good results without any complications.

Pneumatization of the sphenoid sinus and its surrounding neurovascular structures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sphenoid sinus faces the cavernous sinuses in which neurovascular structures such as the cavernous segment of the internal carotid arteries (ICA), optic nerve, and trigerminal nerve are located. In addition, it separates the pituitary gland from the nasal cavity. Therefore, surgeons are required to understand its detailed anatomy for transsphenoidal approach (TSA) or optic nerve decompression. This study is aimed to investigate the surgical anatomy of the sphenoid sinus and its clinical application using Korean adult cadaveric heads. MATERIAL AND METHODS: One hundred sagittally-divided adult cadaveric heads were used. After removing the sinus mucosa meticulously, careful examination and photodocumentation were done serially. The analysed items were the pneumatization type of the sphenoid sinus, the relationship between the pneumatization type of the sphenoid sinus and the incidence of bulging of the optic canal, segment 1 and 3 of ICA, maxillary nerve, and pterygoid nerve, and the incidence of bony dehiscence and thickness of bone at the bulging site of various neurovascular structures. RESULT: The sellar type was found in 90% of the subjects. The incidence of bulging of neurovascular structures were from 34% to 65%, and the incidence of bony dehiscence at the bulging site were from 0% to 9.6%. The more pnermatized the sphenoid bone was, the higher the prevalence of bulging became. The average thickness of bone was less than 0.5 mm. In the complete sellar type, the distances from the anterior wall of the sphenoid sinus to the bulging site at the optic canal, and to segment 1 and 3 of ICA were about 1.9 mm, 19.3 mm, and 9.5 mm, respectively. The distances from the superior wall of the sphenoid sinus to the bulging site at the optic canal and to the maxillary nerve were about 3.7 mm and 17.3 mm, respectively. Bulging of the optic canal attached to the anterior and the superior walls of the sphenoid sinus was 45% and 34%, respectively. CONCLUSION: By elucidating the relationship between the sphenoid sinus and surrounding vital neurovascular structures, this study might be able to provide essential anatomical knowledge for surgeons to reduce surgical complication in applying to the sphenoid sinus.