Suprazygomatic maxillary nerve block: an ultrasound and cadaveric study to identify correct sonoanatomical landmarks
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Suprazygomatic maxillary nerve block: an ultrasound and cadaveric study to identify correct sonoanatomical landmarks Danny Mireault1 · Thomas R. Cawthorn2 · Anna R. Todd2 · Adam O. Spencer3 Received: 27 August 2020 / Accepted: 7 November 2020 © Japanese Society of Anesthesiologists 2020
Abstract Purpose Suprazygomatic maxillary nerve blocks (SMB) are used in adult and pediatric patients to provide analgesia for midface surgery and chronic maxillofacial pain syndromes. The ultrasound-guided SMB technique ensures visualisation of the needle tip, avoidance of the maxillary artery and confirmation of local anesthetic spread. The goal of this study was to correctly identify SMB sonoanatomical landmarks to ensure the nerve block is performed safely and effectively. Methods Following an ultrasound-guided SMB with dye injection on 2 embalmed cadavers, pre-tragal face-lift style incision with a full thickness flap dissection was performed allowing accurate visualization of the bony landmarks being used for sonography and identification of the location of the injected dye. Results This study identifies the correct sonoanatomic landmarks as the maxilla and the coronoid process of the mandible which suggests that the block needle tip and local anesthetic injection are within the infratemporal fossa as opposed to the previously reported pterygopalatine fossa. Conclusion An improved understanding of the sonoanatomy will aid clinicians who are learning, performing and teaching the ultrasound-guided suprazygomatic approach to the maxillary nerve block. Keywords Suprazygomatic maxillary nerve block · Ultrasound-guided regional anesthesia · Facial nerve blocks · Cleft palate and alveolar bone graft surgery · Maxillofacial pain syndromes Ultrasound-guided suprazygomatic maxillary nerve blocks (SMB) are used in pediatric and adult patients to provide anesthesia and analgesia for midface surgery and chronic maxillofacial pain syndromes. SMB are used for pediatric patients undergoing cleft palate or alveolar bone graft surgery. Studies have shown a reduction in postoperative opioid requirements, thereby reducing opioid related adverse effects and promoting early feeding and early discharge [1–3]. Although this block was originally performed using surface anatomy landmarks, Sola et al. described the use of * Adam O. Spencer [email protected] 1
Department of Anesthesia, Ste-Justine Hospital, University of Montreal, Montreal, QC, Canada
2
Department of Surgery, Section of Plastic and Reconstructive Surgery, Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
3
Department of Pediatric Anesthesia, Alberta Children’s Hospital, University of Calgary, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada
ultrasound guidance to improve the safety and confirmation of local anesthetic injection [4]. At our institution, the ultrasound-guided SMB was included as part of a perioperative care pathway for patients undergoing cleft palate surgery or alveolar bone graft repair as a means to improv
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