Aker F D
Temple University School of Medicine, Department of Anatomy and Cell Biology, Philadelphia, Pennsylvania 19140, USA.
Clin Anat. 2001;14(2):111-9. doi: 10.1002/1098-2353(200103)14:2<111::AID-CA1019>3.0.CO;2-3.
The anatomic relations of the buccal nerve branch of the mandibular division of the trigeminal nerve were studied to explain the rationale for the discrepancy in blocking the buccal nerve using two methods of blocking the inferior alveolar nerve, the conventional method and the Gow-Gates method. The conventional method rarely blocks the buccal nerve, while the Gow-Gates method is reported to consistently block the buccal nerve. Eight head and mandibular specimens were dissected to observe the path of buccal nerve and its relationship to the path of needles in the conventional and Gow-Gates techniques. The buccal nerve descends on the medial and then anterior aspect of the deep head of the temporalis muscle (Tdh). At the latter position the buccal nerve enters the retromolar fossa and is encased in a fascial sleeve created by a dense fascial band that spans between the temporalis muscle tendons and the buccinator muscle. At the level of the conventional block injection the buccal nerve was shielded from the path of the needle by the Tdh and the fascial band. In the Gow-Gates block injection, the buccal nerve was exposed on the medial surface of the Tdh, immediately lateral to the path of the needle and proximal to the fascial sleeve. Consequently, the anatomical relations of the buccal nerve in the conventional block method essentially shield the nerve from being bathed by anesthetic solution while in the Gow-Gates method the relations are such that the buccal nerve can be exposed to anesthetic solution and thus blocked, explaining the findings in clinical dentistry.
研究三叉神经下颌支颊神经分支的解剖关系，以解释使用两种下牙槽神经阻滞方法（传统方法和Gow-Gates方法）阻滞颊神经时出现差异的原因。传统方法很少能阻滞颊神经，而据报道Gow-Gates方法能持续阻滞颊神经。解剖8个头部和下颌标本，观察颊神经的走行及其与传统技术和Gow-Gates技术中针道的关系。颊神经在下颞肌深头（Tdh）的内侧然后在前侧下行。在后者位置，颊神经进入磨牙后窝，并被一个由致密筋膜带形成的筋膜套包裹，该筋膜带横跨颞肌腱和颊肌之间。在传统阻滞注射水平，颊神经被Tdh和筋膜带遮挡，使其不暴露于针道。在Gow-Gates阻滞注射中，颊神经暴露于Tdh的内侧表面，紧邻针道外侧且在筋膜套近端。因此，传统阻滞方法中颊神经的解剖关系基本上使其免受麻醉药溶液的浸润，而在Gow-Gates方法中，这种关系使得颊神经能够接触到麻醉药溶液从而被阻滞，这就解释了临床牙科中的发现。
