Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan.
Department of Anatomy, Kyorin University Faculty of Medicine, Mitaka, Tokyo, Japan.
J Anesth. 2024 Dec;38(6):806-810. doi: 10.1007/s00540-024-03396-4. Epub 2024 Aug 29.
Inferior alveolar nerve (IAN) and lingual nerve (LN) blocks are commonly performed using the intraoral landmark techniques. However, these methods have a risk of unanticipated nerve and arterial injury or a higher failure rate. We developed a novel extraoral approach for the IAN and LN blocks, the "inferior alveolar nerve block mandibular angle approach (IANB-MA)," using ultrasound guidance. The mechanism of action of this nerve block was examined anatomically, and its clinical feasibility was reported.
We performed the IANB-MA on four cadavers using different dye volumes (2, 4, 6 and 8 mL). The ultrasound probe was placed on the lower edge of the mandibula of each cadaver, and the needle was advanced to the mandibular inner surface. Blue acrylic paint solution was injected, and its spread was evaluated by dissection.
Our study showed that the medial pterygoid muscle fascia was stained in all cadavers. The dye reached the LN consistently, and the IAN was stained with higher volumes (6 mL and 8 mL). The pterygomandibular space was filled with 6 mL and 8 mL of the dye. The IANB-MA successfully reduced pain in three patients with trigeminal neuralgia, tongue or jaw pain.
The IANB-MA is a novel ultrasound-guided approach to the IAN and the LN. The clinical feasibility and effectiveness of this technique were confirmed in our patients. It may be a good alternative analgesic approach to other conventional approaches.
下牙槽神经（IAN）和舌神经（LN）阻滞通常采用口腔内标志技术进行。然而，这些方法存在神经和动脉意外损伤或更高失败率的风险。我们使用超声引导开发了一种新的IAN 和 LN 阻滞的颌面外入路，即“下颌角下牙槽神经阻滞（IANB-MA）”。该神经阻滞的作用机制进行了解剖学检查，并报告了其临床可行性。
我们在 4 具尸体上使用不同的染料体积（2、4、6 和 8 ml）进行 IANB-MA。将超声探头放置在每个尸体下颌骨的下缘，将针推进下颌骨的内表面。注射蓝色丙烯酸涂料溶液，并通过解剖评估其扩散情况。
我们的研究表明，所有尸体的翼内肌筋膜均被染色。染料始终到达 LN，且使用更高体积（6 ml 和 8 ml）时 IAN 被染色。翼下颌间隙充满了 6 ml 和 8 ml 的染料。IANB-MA 成功减轻了 3 例三叉神经痛、舌或颌痛患者的疼痛。
IANB-MA 是一种新的超声引导下的IAN 和 LN 入路方法。我们的患者证实了该技术的临床可行性和有效性。它可能是其他传统方法的一种良好替代镇痛方法。
