Simulation of local anaesthetic nerve block of the infraorbital nerve within the pterygopalatine fossa: anatomical landmarks defined by computed tomography.
Abstract: To provide anaesthesia of the maxillary cheek teeth, a local block of the infraorbital nerve in the pterygopalatine fossa has been suggested. The aim of this study was to re-examine the anatomy of the pterygopalatine fossa, giving special attention to relevant arteries, veins and nerves; simulate the infiltration of an anaesthetic by injecting a contrast medium; improve the injection technique to avoid puncturing of relevant anatomical structures. Five heads and two living horses were investigated using contrast medium injections and computed tomography (CT). Needles were inserted using two insertion techniques: "Palatine Bone Insertion" (PBI) and "Extraperiorbital Fat Body Insertion" (EFBI). Both techniques are suitable for achieving a consistent distribution of contrast medium around the infraorbital nerve. The periorbita prevents the contrast medium from penetrating into the intraperiorbital compartment. The EFBI-technique is most appropriate for providing a sufficient infraorbital nerve block with a minimised risk of complications.
Publication Date: 2008-03-26 PubMed ID: 18371997DOI: 10.1016/j.rvsc.2008.02.008Google Scholar: Lookup
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Summary
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The research study explores an improved method for administering an anaesthetic block to the infraorbital nerve in the pterygopalatine fossa to numb the maxillary cheek teeth, utilizing computed tomography to define anatomical landmarks and mitigate the risk of puncturing significant structures during injection.
Anatomy of the Pterygopalatine Fossa and Injection Techniques
- The pterygopalatine fossa is an intricate anatomical region housing important nerves, arteries, and veins. Profound understanding of this region is critical to successfully administer an anaesthetic nerve block.
- Anatomical landmarks were thoroughly examined to establish a safe and efficient way to inject an anaesthetic into the pterygopalatine fossa.
- The study employed contrast medium injections and computed tomography (CT) to simulate the infiltration of an anaesthetic. The contrast medium helped visualise the path and distribution of the injected substance, allowing for a better assessment of the injection techniques used.
Palatine Bone Insertion (PBI) and Extraperiorbital Fat Body Insertion (EFBI)
- Two different techniques were used for needle insertion: Palatine Bone Insertion (PBI) and Extraperiorbital Fat Body Insertion (EFBI).
- The aim was to determine which method provided more consistent results with the least risk. Both methods demonstrated consistent contrast medium distribution around the infraorbital nerve during their respective injections.
Prevention of Penetration to the Intraperiorbital Compartment
- The study revealed that the periorbita, a membranous tissue surrounding the eyeball, prevented the contrast medium from penetrating into the intraperiorbital compartment. This observation is significant as it can help avoid possible complications due to unwanted anaesthetic spread.
Appropriate Technique for Infraorbital Nerve Block
- The EFBI technique emerged as the most suitable method for achieving a sufficient infraorbital nerve block. In comparison to the PBI, the EFBI method was associated with minimal risks while effectively providing the desired anaesthesia.
- These findings suggest that with careful positioning guided by anatomical landmarks, a safe and effective infraorbital nerve block can be achieved. Additionally, the use of computed tomography proved to be instrumental in accurately defining these crucial landmarks.
Cite This Article
APA
Staszyk C, Bienert A, Bäumer W, Feige K, Gasse H.
(2008).
Simulation of local anaesthetic nerve block of the infraorbital nerve within the pterygopalatine fossa: anatomical landmarks defined by computed tomography.
Res Vet Sci, 85(3), 399-406.
https://doi.org/10.1016/j.rvsc.2008.02.008 Publication
Researcher Affiliations
- Institute of Anatomy, University of Veterinary Medicine Hannover, Bischofsholer Damm 15, Hannover, Germany. Carsten.Staszyk@tiho-hannover.de
MeSH Terms
- Anesthetics, Local / therapeutic use
- Animals
- Autopsy
- Cadaver
- Facial Nerve / diagnostic imaging
- Facial Nerve / drug effects
- Female
- Horses
- Male
- Nerve Block / methods
- Nerve Block / veterinary
- Palate, Hard / anatomy & histology
- Palate, Hard / diagnostic imaging
- Palate, Hard / pathology
- Tomography, X-Ray Computed
- Tooth Extraction / methods
- Tooth Extraction / veterinary
Citations
This article has been cited 7 times.- Jehle MC, Biermann NM, Haltmayer E. Trephination versus Minimally Invasive Transnasal Approaches for the Diagnosis and Treatment of Sinus Disease in Horses.. Vet Sci 2022 Jul 1;9(7).
- Vuerich M, Nannarone S. Retrograde Approach to Maxillary Nerve Block: An Alternative in Orofacial Surgeries in Horses.. Animals (Basel) 2022 May 27;12(11).
- Pezzanite LM, Hackett ES, McCready E, Easley JT. Outcomes following single, caudally based bilateral versus unilateral frontonasal sinusotomy for treatment of equine paranasal sinus disease.. Vet Med Sci 2021 Nov;7(6):2209-2218.
- Vlaminck L, Pollaris E, Vanderperren K, Tremaine WH, Raes E. Diagnosis and Surgical Treatment of Idiopathic Primary Sino-Nasal Obstruction in Miniature Horse Breeds: Long-Term Follow-Up of Seven Cases.. Front Vet Sci 2021;8:680150.
- Carroll KA, Mathews KG. Ligation of the Maxillary Artery Prior to Caudal Maxillectomy in the Dog-A Description of the Technique, Retrospective Evaluation of Blood Loss, and Cadaveric Evaluation of Maxillary Artery Anatomy.. Front Vet Sci 2020;7:588945.
- Bach FS, Böhler A, Schieder K, Handschuh S, Simhofer H. Surgical enlargement of the nasomaxillary aperture and transnasal conchotomy of the ventral conchal sinus: Two surgical techniques to improve sinus drainage in horses.. Vet Surg 2019 Aug;48(6):1019-1031.
- Haltmayer E, Simhofer H. Progressive ossifying paranasal sinus mass of suspected traumatic origin in a mare: Surgical treatment and follow-up.. Can Vet J 2018 Aug;59(8):866-870.
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