Radder Kiran, Shah Ashwin, Fatima Shereen, Kothari Chaitanya, Zakaullah Syed, Siddiqua Aaisha
Department of Oral and Maxillofacial Surgery, Al Badar Rural Dental College and Hospital, Gulbarga, Karnataka India.
J Maxillofac Oral Surg. 2014 Sep;13(3):231-7. doi: 10.1007/s12663-013-0514-7. Epub 2013 Apr 21.
Pain control is an integral part of minor oral surgery and maxillary/mandibular nerve blocks have proved promising in achieving the same. Although intra oral techniques of maxillary nerve block are common and are widely used, there are certain inherent disadvantages and potential complications. Less commonly described in the literature, the extra oral techniques have a wide spectrum of indications as well as can be more advantageous than the intra oral approach. This prospective clinical trial is an attempt to evaluate the feasibility and the efficacy of the extra oral frontozygomatic approach to the foramen rotundum to block the maxillary nerve.
Sample size was 100 patients and the inclusion criteria were patients of ASA I or II category who needed extraction of a minimum of 4 maxillary teeth in the same quadrant in a single sitting while exclusion criteria were patients with a history of allergy to local anesthesia, medically compromised patients in whom dental extraction was contraindicated. Mean age was 71.9 years and 56 patients were males while 44 were females. Only a single quadrant (first or second) was chosen as the operative site in each patient and local anaesthesia was secured using a 21 gauge 89 mm long spinal needle with frontozygomatic angle approach and the parameters used were pain experienced during the injection, onset of subjective symptoms, time required for the peak effect (objective symptoms), pain during extraction and the duration of anesthesia. All the parameters were expressed as mean values with standard deviations.
A successful anesthesia was secured in first attempt in 98 patients while in 2 patients, the procedure had to be repeated owing to the difficulty in reaching the target site. A majority of the patients i.e., 71 % scored 0-2 (no pain) on visual analogue scale (VAS) while only 2 patients experienced a moderate degree of pain. Subjective symptoms were reported in 27.24 s (mean value) and 12.93 s (mean value) in the palate and the infraorbital fossa respectively. Peak effect of anesthesia was noted in 66.7, 37.38 and 31.71 s (all values expressed as mean) in palate, infraorbital fossa and posterior superior alveolar areas respectively.
Although with only dental extraction as the procedure of choice, the present study has favoured the frontozygomatic angle approach for the maxillary nerve block as simple, safe, efficacious and associated with minimum and clinically mild complications.
疼痛控制是口腔小手术的一个重要组成部分，上颌/下颌神经阻滞在实现这一目标方面已被证明很有前景。尽管上颌神经阻滞的口内技术很常见且被广泛应用，但存在一些固有的缺点和潜在并发症。文献中较少描述的口外技术有广泛的适应证，并且可能比口内方法更具优势。这项前瞻性临床试验旨在评估经口外额颧入路至圆孔阻滞上颌神经的可行性和有效性。
样本量为100例患者，纳入标准为美国麻醉医师协会（ASA）I或II级患者，这些患者需要在一次就诊中拔除同一象限至少4颗上颌牙，排除标准为有局部麻醉过敏史的患者、存在拔牙禁忌的身体状况不佳的患者。平均年龄为71.9岁，男性56例，女性44例。每位患者仅选择一个象限（第一或第二象限）作为手术部位，使用21号89毫米长的脊麻针采用额颧角入路确保局部麻醉，所使用的参数包括注射时的疼痛、主观症状的出现、达到峰值效应所需的时间（客观症状）、拔牙时的疼痛以及麻醉持续时间。所有参数均以平均值和标准差表示。
98例患者首次尝试即成功实现麻醉，2例患者因难以到达目标部位而需重复操作。大多数患者（即71%）在视觉模拟量表（VAS）上得分为0 - 2分（无疼痛），只有2例患者经历了中度疼痛。腭部和眶下窝分别在27.24秒（平均值）和12.93秒（平均值）出现主观症状。腭部、眶下窝和后上牙槽区域分别在66.7秒、37.38秒和31.71秒（均为平均值）达到麻醉峰值效应。
尽管本研究仅以拔牙作为选择的操作，但目前的研究支持额颧角入路进行上颌神经阻滞，因其简单、安全、有效，且并发症最少且临床症状轻微。
