Blocks of the foramen rotundum and the oval foramen: a reappraisal of extraoral maxillary and mandibular nerve injections

OBJECTIVE

To present our experience of regional anaesthesia with blocks of the foramen rotundum and the oval foramen.

DESIGN

Open study.

SETTING

University Hospital, Beograd, Yugoslavia.

SUBJECTS

107 patients who underwent 58 maxillary and 49 mandibular nerve blocks.

INTERVENTIONS

Injection of 2% lignocaine with adrenaline 1/80,000 with an 18 G venflon or 20 G spinal needle.

MAIN OUTCOME MEASURES

Quality of anaesthesia and morbidity.

RESULTS

49 of the 58 maxillary (84%) and 45 of the 49 mandibular (92%) nerve blocks were successful (no sensitivity to pinprick in the distribution of the injected nerve and a painless operation). There were 17 complications (26%), 8 in the maxillary and 9 in the mandibular group. All complications were minor and transient, and 6 could be attributed to anhydrous glycerol rather than the injection technique itself.

CONCLUSION

Blocks of the foramen rotundum and the oval foramen achieve good regional anaesthesia in the maxillofacial region.

Peripheral streptomycin/lidocaine injections versus lidocaine alone in the treatment of idiopathic trigeminal neuralgia. A double blind controlled trial

Seventeen patients with long-lasting idiopathic trigeminal neuralgia (ITN) were treated with either five, weekly peripheral streptomycin/lidocaine (S/L) or lidocaine alone injections, in a double blind controlled study. Eight patients responded initially to the treatment in the S/L group and three patients in the lidocaine group. Pain recurred in four patients from the S/L group within two weeks and six months following the last injection. One patient from the lidocaine group remained pain-free for eight months. At the final assessment, three patients from the S/L group and two patients from the lidocaine group remained pain-free up to 30 months. Neither treatment affected sensory functions of the injected nerves. It is concluded that S/L injections are initially effective in the treatment of ITN. In the long term, however, their effects are similar to the effects of lidocaine alone.

[Apicoectomy performed after supervoltage radiotherapy in the region of oral cavity and neck: case report]

The author describes a case of apicoectomy of the lower canine in a patient who was previously exposed to supervoltage radiotherapy in the oral cavity and neck regions. After the comment on the uneventful postoperative course and the absence of complications one year and a half later, the author points out that apicoectomy should be taken into account when dental care of irradiated patients was planned.

[Possible usage of parallax phenomenon in dental radiography]

The authors describe a method of X-ray recording which uses the phenomenon of parallax in determination of exact localisation and inter-relationship of some elements within the upper and lower jaws. By describing the method in detail, the authors also point out its advantages in everyday estimation of the position of impacted teeth and their relationship to the surrounding anatomical points.

Mandibular versus inferior dental anaesthesia: clinical assessment of 3 different techniques

Inferior dental anaesthesia via the direct intraoral approach, mandibular conduction anaesthesia via extraoral landmarks (Gow-Gates) and mandibular conduction anaesthesia via the tuberosity approach (Akinosi) were evaluated using onset and duration of anaesthesia, pain during injection, aspiration test, pinprick, depth and frequency of anaesthesia. 90 patients undergoing simple tooth extraction were randomly selected into 3 groups. They were given injections of 2 ml of 2% lidocaine with adrenaline (1:80,000). All techniques were mostly painless, none of them showing any special advantage in that sense. The differences in duration of anaesthesia among the applied techniques were insignificant. Positive aspirations were most frequently observed with the direct method of inferior dental anaesthesia, but this method gave the best result for the frequency of anaesthesia. After using the Gow-Gates method, the external branches of the buccal nerve were usually anaesthetized but the onset of anaesthesia was relatively slow. Mandibular conduction anaesthesia via the tuberosity approach did not show any particular advantage over the other 2 techniques in this investigation. A progress study is needed to determine more precisely the aspiration rate and frequency of anaesthesia for all the techniques.

Peripheral streptomycin/lidocaine injections in the treatment of idiopathic trigeminal neuralgia. A preliminary report

Streptomycin sulphate dissolved in 2% lidocaine solution was deposited adjacent to peripheral branches of maxillary or mandibular nerves in 20 patients with idiopathic trigeminal neuralgia. The patients were given five injections at approximately one week intervals. In the postinjection period, once the local anaesthetic had worn off, apparently normal sensation returned. All patients obtained pain relief, only four having a recurrence of symptoms. The remaining 16 patients remained free of pain after periods of up to 30 months.

Abscopal effects of local fractionated X-irradiation of face and jaw region

The abscopal effects of high doses of X-irradiation, 6000 R given in 12 fractions locally on rat face and jaw region, upon the haematopoietic and lymphatic tissues, were studied. Haematological and pathophysiological studies were performed. Peripheral blood samples were taken after the 7th, 17th and 27th day during the course of the irradiation. 24 hours after the last irradiation the smears of femur bone-marrow were done. In the smears, the cells of erythrocyte and leukocyte series, as well as their mitotic index were determined. 24 hours after the irradiation the pieces of lymph nodes and salivary glands were taken for histological analysis. A significant depression of peripheral leukocyte counts was found in all observation intervals as well as the change in mitotic index of granulocyte series in bone marrow. No significant histological changes on the lymph nodes and salivary gland section were found 24 hours after the last irradiation.