Ultrasound-Guided Inferior Alveolar Nerve Block in the Horse: Assessment of the Extraoral Approach in Cadavers.
Abstract: Blinded techniques to desensitize the inferior alveolar nerve (IAN) include intraoral, angled, and vertical extraoral approaches with reported success rates of 100%, 73%, and 59%, respectively. It has not been determined whether an ultrasound-guided extraoral approach is feasible. Further, the fascicular nature of the inferior alveolar and lingual nerves of the horse has not been described. The objectives of this study were to describe a low-volume ultrasound-guided vertical extraoral inferior alveolar nerve block technique and to describe the fascicular nature of these nerves. An ultrasound-guided approach to the IAN was conducted with a microconvex transducer and an 18-G, 15-cm spinal needle using a solution containing iodinated-contrast and methylene blue dye. Accuracy was assessed by contrast visualized at the mandibular foramen on computed tomography (CT) and methylene blue dye staining of the nerves on gross dissection. Sections of inferior alveolar and lingual nerves were submitted for histological analysis. Assessment by CT and dissection determined success rates of 81.3% and 68.8%, respectively; 68.8% of injections had inadvertent methylene blue dye staining of the lingual nerve. Nerve histology revealed both the inferior alveolar and lingual nerves to be multifascicular in nature. Mean fascicle counts for the inferior alveolar and lingual nerves were 29 and 30.8, respectively. The technique is challenging and no more accurate than previously published blinded techniques. Any extraoral approach to the IAN is likely to also desensitize the lingual nerve.
Publication Date: 2019-05-30 PubMed ID: 31138051DOI: 10.1177/0898756419844836Google Scholar: Lookup
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- Journal Article
Summary
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This study investigates the feasibility of an ultrasound-guided procedure to block the inferior alveolar nerve (IAN) in horses. Despite the challenges and potential risks, the method showed comparable accuracy to other existing techniques, albeit likely to result in the desensitization of the adjacent lingual nerve.
Objective and Methodology of the Study
- The main objectives of this research were to evaluate a novel ultrasound-guided method to block the IAN using a vertical extraoral approach and to describe the structure (fascicular nature) of both the inferior alveolar and lingual nerves in horses.
- Researchers used a microconvex transducer and an 18-G, 15-cm spinal needle with an iodinated-contrast and methylene blue dye solution to conduct the technique.
Evaluation of the Technique
- The success and accuracy of this technique were gauged by the visualization of the contrast at the mandibular foramen on CT scanning and through the detection of methylene blue dye on the nerves throughout direct dissection.
- Parts of the inferior alveolar and lingual nerves were submitted for histological examination to further understand their structure.
Results of the Study
- According to both CT scanning and direct dissection, the success rates of this ultrasound-guided approach were determined to be 81.3% and 68.8%, respectively.
- Around 68.8% of the time, injection of the dye resulted in inadvertent staining of the lingual nerve, suggesting that this technique may also block the lingual nerve.
- Both the inferior alveolar and lingual nerves were found to be multifascicular (containing multiple bundles of nerve fibers) in their structural composition, with average fascicle counts of 29 for IAN and 30.8 for the lingual nerve.
Conclusion
- The study concluded that while the ultrasound-guided approach to block the IAN might be technically challenging, its accuracy level is similar to those of previously established methods.
- The results also indicated a probability of the lingual nerve becoming desensitized with any extraoral approach to the IAN.
Cite This Article
APA
Johnson JP, Peckham RK, Rowan C, Wolfe A, O'Leary JM.
(2019).
Ultrasound-Guided Inferior Alveolar Nerve Block in the Horse: Assessment of the Extraoral Approach in Cadavers.
J Vet Dent, 36(1), 46-51.
https://doi.org/10.1177/0898756419844836 Publication
Researcher Affiliations
- 1 Equine Veterinary Medical Center, Member of Qatar Foundation, Al Shaqab, Doha, Qatar.
- 2 Archway Veterinary Practice, Grange-over-Sands, Cumbria, United Kingdom.
- 3 University College Dublin Veterinary Hospital, Belfield, Dublin, Ireland.
- 3 University College Dublin Veterinary Hospital, Belfield, Dublin, Ireland.
- 3 University College Dublin Veterinary Hospital, Belfield, Dublin, Ireland.
MeSH Terms
- Animals
- Cadaver
- Horses / surgery
- Lingual Nerve / drug effects
- Lingual Nerve / physiology
- Lingual Nerve / surgery
- Mandibular Nerve / drug effects
- Mandibular Nerve / physiology
- Mandibular Nerve / surgery
- Nerve Block / instrumentation
- Nerve Block / methods
- Nerve Block / veterinary
- Ultrasonography / veterinary
Citations
This article has been cited 1 times.- Johnson JP, Vinardell T, David F. Ultrasound-guided injections of the equine head and neck: review and expert opinion.. J Equine Sci 2021 Dec;32(4):103-115.
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