Suprazygomatic access for continuous bilateral mandibular nerve block for pain and trismus relief in the tetraplegic patient

Publication date: Available online 20 May 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mikhail A. Dziadzko, Fabrice Heritier
BackgroundExtraoral mandibular nerve block (MNB) is used in oropharyngeal surgery for analgesia and/or anesthesia. Repeated or continuous MNB has been used successfully as a treatment for uncontrollable pain, masseter spasticity, and airway assessment. The usual technique is a transcutaneous infrazygomatic access. However, in some specific settings this approach is not always feasible.MethodsA continuous bilateral MNB with a suprazygomatic approach to the pterygomandibular space was used to resolve a case of refractory and painful trismus in tetraplegic patient.ResultAnalgesia was achieved and maintained by bilateral catheter placement to the pterygomandibular space and repeated injection of local anesthetic for 48 hours. The right-side catheter was accidentally withdrawn; the left-side catheter was maintained up to 72 hours. The efficiency of analgesia was not affected. This block provided effective analgesia within the first few hours after local anesthetic injection, helped to improve mouth opening, and resolved acute pain. As kinesitherapy could then be introduced, the patient was left on non-opioid analgesics.ConclusionContinuous bilateral mandibular nerve block via the suprazygomatic approach was used safely and efficiently. The suggested approach is quite unique as well as the clinical circumstance, and may be considered when the usual technique is challenging.



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