Clinical significance of the length of the pterygopalatine fissure in dental anesthesia

Effectiveness and Distribution of Anesthesia for a Modified Extra Oral Maxillo-Mandibular Nerve Block for Dento-Alveolar Procedures: A Prospective Cohort Study

Aim

To evaluate the effectiveness of a modified maxillo-mandibular nerve block technique that includes anesthetizing the maxillary and mandibular nerve with single injection.

Materials and Methods

A prospective, clinical cohort study was carried out including patients who presented for surgical removal of maxillary and mandibular third molars. All patients were administered maxilla-mandibular nerve block through a single injection on one side. Three clinical neurosensory tests were used for mapping the area of anesthesia and to assess and grade objectively the effect of the block. Light touch (LT), two-point discrimination (TPD), pin prick (PP) and Electric pulp testing (EPT) were used for all branches of maxillary and mandibular nerve. An extra oral mapping chart for depth of anesthesia was maintained for each patient to categorize the grades as nil, intermediate and highly anesthetized areas.

Results

62 patients were assessed in the study. EPT showed greater depth of pulpal anesthesia in posterior teeth than the anterior in both maxilla and mandible. PP and TPD tests also showed that the anesthetic effect varied between posterior divisions demonstrating extreme anesthesia compared to the anterior divisions.

Conclusion

This technique was found to be successful for surgical extractions involving the maxillary and mandibular regions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-022-01755-w.

Relationship between pterygomaxillary fissure morphology and maxillary/mandibular position : A cone beam computed tomography assessment

PURPOSE

The aim of this study was to investigate the possible correlation between maxillary and mandibular positioning via cephalometric analysis with pterygomaxillary fissure (PMF) morphology using cone beam computed tomography (CBCT).

METHODS

In this study, CBCT images from 825 individuals (448 female, 377 male; age range was 18-91 years with this cohort) were analyzed; PMF length and width were measured. Three-dimensional cephalometric analysis was also performed using cephalometric analysis software. The landmarks and measurements in relation to maxillary and mandibular positions were identified and performed for the cephalometric analysis. Analysis of variance (ANOVA) was used for comparison of the parameters, while the Bonferroni test was used for multiple comparisons. Pearson's test was also used to assess the correlations between the parameters.

RESULTS

The results showed that males had significantly larger PMF length (p < 0.001) and width (p < 0.001) compared to females. The mean PMF length was 17.7 mm (standard deviation [SD] 3.2 mm) for right and 17.7 mm (SD 3.3 mm) for left but were not significantly different (p > 0.05). In terms of the cephalometric measurements, a significant correlation was found between upper central incisor (U1toAperp2D) and posterior facial height (PostFaceHtSGo2D) and PMF length, while correlations were found between PMF width and several cephalometric parameters such as lower lip (LwLiptoEPln2D and LwLiptoHLine2D) and occlusal plane (OPtoFHAng2D) (p < 0.05).

CONCLUSION

A significant relationship was observed between PMF morphology and the position of the maxilla or mandible. PMF lengths and widths were larger in males than females. Posteroanterior maxillary and mandibular lengths and posterior facial height are associated with PMF length and width.

Cone-beam computed tomography evaluation of the pterygomaxillary fissure and pterygopalatine fossa using 3D rendering programs

PURPOSE

The aim of this study was to investigate the detailed anatomy of the pterygomaxillary fissure (PMF) and pterygopalatine fossa (PPF) and variations therein using three-dimensional (3D) cone-beam computed tomography (CBCT) software.

METHODS

This study was based on a retrospective evaluation of CBCT scans. A total of 825 CBCT images of patients (448 females, 377 males) who met the inclusion criteria were analyzed. PMF shapes were classified, and morphometric measurements (PMF area and PPF volume) were performed according to age, right/left side, and gender using 3D rendering programs. Maxillary and sphenoid sinus pathologies were also classified to reveal possible correlations between morphometric measurements. Analysis of variance was used for comparisons. Multiple comparisons were assessed using the Bonferroni test. Pearson's test was used to assess correlations between parameters. A p value < 0.05 was considered to indicate statistical significance.

RESULTS

Six types of PMF shapes were defined. There were no significant differences in types according to gender, age or sinus pathology. Males had a significantly larger PMF area than females (p < 0.001). Left/right comparison of the PMF area revealed that the mean PMF coronal, axial, and sagittal area dimensions were significantly higher on the right side in all patients. Our results also indicated that the PMF area and PPF volume increased significantly after 40 years of age.

CONCLUSION

Various PMF shapes were defined and classified. PMF and PPF dimensions increased with age. Knowledge of these anatomical variations will allow surgeons to avoid damage to the neurovascular structures passing through the area.

Efficacy and feasibility of frontozygomatic angle approach for extra oral maxillary nerve block in oral surgery: a descriptive clinical trial

BACKGROUND

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.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSION

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.

A prospective, randomized comparison of the anesthetic efficacy of the greater palatine and high tuberosity second division nerve blocks

INTRODUCTION

Few clinical studies have evaluated the efficacy of the maxillary second division nerve block. The purpose of this prospective, randomized study was to compare the anesthetic efficacy of the greater palatine second division nerve block and the high tuberosity second division nerve block technique by using 3.6 mL of 2% lidocaine with 1:100,000 epinephrine.

METHODS

Forty subjects randomly received greater palatine nerve blocks and high tuberosity nerve blocks of 3.6 mL of 2% lidocaine with 1:100,000 epinephrine at 2 separate appointments spaced at least 1 week apart. The anterior, premolar, and molar teeth were pulp tested in 4-minute cycles for a total of 60 minutes.

RESULTS AND CONCLUSIONS

Both techniques resulted in a high success rate of pulpal anesthesia (95%-100%) for first and second molars. Around 70%-80% of the second premolars were anesthetized with both techniques. Both techniques were ineffective for profound pulpal anesthesia of the anterior teeth and first premolars.