Karthikeyan Thivviyan, Subramanian Abinaya, Narayanan Vivek, Seetaram Mahima
Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Chengalpattu, Chennai, Tamilnadu 603203 India.
J Maxillofac Oral Surg. 2025 Feb;24(1):267-273. doi: 10.1007/s12663-024-02418-8. Epub 2024 Dec 29.
BACKGROUND/AIM: Mandibular nerve block provides good quality and long-lasting analgesia. In situations necessitating extraoral nerve-blocking procedures, clinicians may find it technically challenging to administer this block due to its uncertain surface landmarks or distorted anatomy. Peripheral nerve stimulator is a device used to electrically stimulate the peripheral and terminal branches of the nerve.
This prospective interventional clinical study was carried out in the Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College And Hospital in patients requiring surgical extraction of mandibular third molar. Patients were divided into two groups: control group and test group based on computer-generated randomization. Control group patients underwent impaction procedure after conventional extraoral mandibular nerve block, while test group patients underwent impaction procedure after PNS-guided extraoral mandibular nerve block.
Statistical analysis was done and the mean length of anaesthesia between the two groups was compared using a paired t test, and the mean pain levels up to six hours were compared using a Wilcoxon signed-rank test. Out of 42 patients, 25 were male and 17 were female. The mean age was 28.36 years. The age range was 19-52 years. In both control and test groups, no patients had failure of anaesthesia, and no one complained of pain during the procedure; hence, no supplemental injections were given. Visual analogue scale score remained (score ≤ 2) up to 6 h for patients in test group.
Thus, using a peripheral nerve stimulator guarantees the success of the block. For patients undergoing third molar surgery, it is a reliable, secure, and safer option for administering extraoral mandibular nerve block. In the future, the use of this technique could extend to pain control during major procedures such as cleft lip and palate, orthognathic, tumour removal, and facial injuries too.
背景/目的：下颌神经阻滞可提供高质量且持久的镇痛效果。在需要进行口外神经阻滞操作的情况下，由于其表面标志不确定或解剖结构变形，临床医生可能会发现实施该阻滞在技术上具有挑战性。外周神经刺激器是一种用于电刺激神经外周和终末分支的设备。
这项前瞻性干预性临床研究在SRM卡坦库拉图尔牙科学院及医院口腔颌面外科进行，研究对象为需要外科拔除下颌第三磨牙的患者。根据计算机生成的随机化方法，将患者分为两组：对照组和试验组。对照组患者在进行传统口外下颌神经阻滞后接受拔除手术，而试验组患者在经外周神经刺激器引导的口外下颌神经阻滞后接受拔除手术。
进行了统计分析，使用配对t检验比较两组之间的平均麻醉时长，并使用Wilcoxon符号秩检验比较长达6小时的平均疼痛水平。42例患者中，男性25例，女性17例。平均年龄为28.36岁。年龄范围为19至52岁。在对照组和试验组中，均无患者麻醉失败，且术中无人抱怨疼痛；因此，未给予补充注射。试验组患者的视觉模拟量表评分在长达6小时内均保持（评分≤2）。
因此，使用外周神经刺激器可确保阻滞成功。对于接受第三磨牙手术的患者，它是实施口外下颌神经阻滞的一种可靠、安全且更安全的选择。未来，该技术的应用还可扩展至唇腭裂、正颌、肿瘤切除及面部损伤等大型手术中的疼痛控制。
