Ultrasound-guided maxillary nerve block via the pterygopalatine fossa: maxillary artery is the key

Ultrasonographic assessment of the lateral pterygoid muscle for BoNT-A injection

The upper head of the lateral pterygoid muscle (LPM) is known to insert into the capsule of the temporomandibular joint and articular disc, and therefore its relationship with temporomandibular disorders (TMD) has been consistently suggested. The aim of the study was to determine the anatomical features of the LPM using ultrasonographic (US) imaging. Around 120 hemifaces from 60 healthy Korean volunteers were included in this study. US images were taken with the subject's mouth 2 cm open. The transducer was placed at a position where the infratemporal fossa could be observed through the mandibular notch, and its position was recorded. The locations of the coronoid process (CorP), lateral margin of the condylar process (ConP), and midpoint of CorP and ConP (MP) were measured with reference to the ala-tragus line. The thicknesses of the skin and subcutaneous tissue, the masseter muscle, the temporalis muscle, and the depth of the LPM were measured at the MP. The masseter muscle, temporalis muscle, and LPM were observed in all cases and located in order from superficial to deep. The MP was located 39.6 ± 3.3 mm anterior and 7.8 ± 1.6 mm inferior to the tragus. The thicknesses of the skin and subcutaneous tissue, the masseter muscle, the temporalis muscle, and the depth of the LPM at the MP were 9.7 ± 1.0, 10.3 ± 1.3, 10.9 ± 1.6, and 30.9 ± 1.9 mm, respectively. The information reported in this study may be useful for determining the location of the LPM and adjacent anatomical structures in TMD patients and provide accurate and safe injection guidelines.