Okuda Y, Okuda K, Shinohara M, Kitajima T
First Department of Anesthesiology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan.
Reg Anesth Pain Med. 2000 Jul-Aug;25(4):417-9. doi: 10.1053/rapm.2000.6447.
Maxillary nerve block has traditionally been performed by using external anatomic landmarks. However, the classic approach to the nerve may be confounded because of anatomic variability. We describe a technique for the block using the suprazygomatic route guided by computed tomography (CT).
A 90-year-old woman had a 30-year history of episodic pain in her right maxillary region. We attempted to block the maxillary nerve with classic technique, but we could not identify the nerve by eliciting paresthesia. In addition, bleeding was noted after repeated attempts. To minimize complications and confirm the correct position of the needle tip, we planned the block with a suprazygomatic approach using CT guidance. The needle was inserted without paresthesia. The CT scan showed the needle tip was placed at the entrance of the pterygopalatine fossa and the distribution of contrast medium spread appropriately around the pterygopalatine fossa. After confirming the clinical effect and lack of complications of the block using the local anesthetic, 0.5 mL of 7% phenol was injected. This technique resulted in complete sensory loss in the area innervated by the maxillary nerve, and did so without complications.
A maxillary nerve block guided by a CT imaging is an alternative to classic techniques.
传统上，上颌神经阻滞是通过使用外部解剖标志来进行的。然而，由于解剖变异，经典的神经阻滞方法可能会受到干扰。我们描述了一种在计算机断层扫描（CT）引导下经颧弓上入路进行神经阻滞的技术。
一名90岁女性有右侧上颌区域发作性疼痛30年的病史。我们试图用经典技术阻滞上颌神经，但未能通过引出感觉异常来确定神经位置。此外，反复尝试后出现了出血。为了尽量减少并发症并确认针尖的正确位置，我们计划采用CT引导下的颧弓上入路进行阻滞。在未引出感觉异常的情况下插入了针头。CT扫描显示针尖位于翼腭窝入口处，造影剂在翼腭窝周围分布适当。在确认使用局部麻醉剂进行阻滞的临床效果且无并发症后，注射了0.5毫升7%的苯酚。该技术导致上颌神经支配区域完全感觉丧失，且未出现并发症。
CT成像引导下的上颌神经阻滞是经典技术的一种替代方法。
