Ultrasound-guided inferior alveolar nerve block for postoperative analgesia after mandibular sequestrectomy: A single-center retrospective study

Perioperative Analgesia Using an Indwelling Catheter to Deliver an Inferior Alveolar Nerve Block: A Case Report

A 74-year-old male was diagnosed with osteomyelitis of the left mandible requiring marginal mandibulectomy under general anesthesia. However, the patient's pulmonary function tests demonstrated findings consistent with severe chronic obstructive pulmonary disease, classified as stage III. The consulting pulmonologist explained the increased risk of respiratory complications associated with general anesthesia and advised against its use. Therefore, we opted to perform the surgery under moderate sedation using 0.2% ropivacaine administered via bilateral ultrasound-guided inferior alveolar nerve blocks (UGIANBs) and an indwelling catheter with a pump for continuous perioperative local anesthesia and prolonged postoperative analgesia. This approach delivered excellent local anesthetic effects without any need for rescue medications or complications. Use of UGIANBs along with an indwelling catheter and pump may provide adequate local anesthesia and postoperative analgesia in patients with contraindications for general anesthesia.

Super Minimally Invasive Pulp Therapy for Severe Pulpitis: A Report of Two Cases

In regions where preventive dentistry is widespread, tooth loss due to root fracture occurs approximately 10 times more frequently than that due to caries and periodontal disease. Root fracture is most likely to occur in non-vital teeth, where the dental pulp has been removed, often through a procedure known as pulpectomy. However, super minimally invasive pulp (SMIP) therapy has recently been reported as a novel treatment approach for pulpitis of any degree. In this study, SMIP therapy was performed to preserve the vitality of teeth in two patients with severe pulpitis. Case one involved a 35-year-old man with a history of hypertension who presented with intense spontaneous pain in tooth #34. The pain was particularly severe while sleeping at night and on exposure to cold water or heat, but it was absent on percussion. Following the detection of cervical caries and severe pulp exposure, SMIP therapy was administered, and the tooth was subsequently restored using glass ionomer cement. Case two involved an 18-year-old woman with no significant medical history who had deep caries in tooth #46. She experienced mild tooth pain when exposed to cold water, and examination revealed pulp exposure. We applied mineral trioxide aggregate over the dental pulp and restored the tooth using composite resin. The vitality of both teeth was maintained at the three-month follow-up. To our knowledge, this is the first report of SMIP therapy for teeth with severe pulpitis. SMIP therapy is an innovative treatment that may cause a paradigm shift from conventional dental treatment.

Considerations for Satisfactory Sedation during Dental Implant Surgery

Implant surgery is a lengthy dental procedure, and sedation is often used to reduce discomfort. The effectiveness of sedation has traditionally been evaluated in terms of patient and surgeon satisfaction, but the most important goal is not to induce a deep sleep in the patient, but rather to ensure that the surgery is performed safely and as planned. Additionally, adequate pain control is a necessary requirement for patient and surgeon satisfaction. Most patients undergoing implant surgery are middle-aged or older, and a relatively large number of them have cardiovascular disease. Infiltration anesthesia using articaine or lidocaine in combination with adrenaline is widely used, but its use in patients with cardiovascular disease is limited because of adrenaline's effects on the cardiovascular system. The use of long-acting local anesthetics and the potential efficacy of ultrasound-guided jaw nerve block have been investigated to enhance analgesia without resorting to adrenaline. Midazolam and propofol are usually used for sedation, but dexmedetomidine, which causes less respiratory depression, and the ultrashort-acting benzodiazepine remimazolam are emerging as potential alternatives. Monitoring of anesthetic depth using electroencephalography is effective in maintaining a constant level of sedation. In addition, sedation promotes the stabilization of heart rate and blood pressure, reducing the risks associated with adrenaline and allowing for safer management.

Maintaining Tooth Vitality With Super Minimally Invasive Pulp Therapy

In aging humans, tooth loss is a predictor of decreased longevity. Tooth loss is mainly caused by dental caries and periodontal disease. Pulpitis refers to inflammation of the dental pulp caused by bacterial infection secondary to dental caries. It is accompanied by severe toothache and has infectious disease-associated pathophysiology. Pulpitis is mainly treated by pulpectomy, which is aimed at removing the infected dental pulp and controlling pain by removing nociceptive nerve fibers. However, teeth without dental pulp have a poor prognosis. In this report, we proposed a novel “super minimally invasive pulp” therapy for treating pulpitis without pulpectomy, which combines antibiotics, steroids, and ultrasound-guided trigeminal nerve block (UGTNB) to protect the dental pulp. UGTNB is used as an analgesic for severe pain, antibiotics for pulp infections, and steroids as antiinflammatory drugs. This novel therapy could improve the longevity of the tooth and thereby oral health.

Jaw Manipulation Using Ultrasound-Guided Inferior Alveolar Nerve Block for Trismus in Temporomandibular Disorders

Temporomandibular disorders are a group of disorders with symptoms that include pain and clicking sounds in the temporomandibular joint and restricted mouth opening. For the treatment of temporomandibular disorders with trismus, herein, we suggest a new approach: “jaw manipulation using the ultrasound-guided inferior alveolar nerve block technique.” A woman in her 60s developed temporomandibular disorders and presented with severe trismus owing to pain in the temporomandibular joint. Ultrasound-guided inferior alveolar nerve block was performed with ropivacaine, which relieved the pain in the patient. Furthermore, we performed jaw manipulation for trismus. Since the analgesic effect lasts for 3 days, self-training can be performed while the pain is relieved. After five sessions of “jaw manipulation using the ultrasound-guided inferior alveolar nerve block technique,” trismus significantly improved in this patient. Ultrasound-guided inferior alveolar nerve block can be effective in relieving temporomandibular disorder-related pain and trismus.

A Novel Pain Relief Approach for the Treatment of Multiple Dental Caries and Pulpitis

Anxiety and stress toward treatment can hamper treatment completion in patients with dental caries and pulpitis. Therefore, effective management of post-treatment pain is important because poor pain management can lead to patient dissatisfaction. Ultrasound-guided nerve blocks provide good postoperative analgesia in maxillofacial surgeries. These surgeries can be performed under general or local anesthesia without complications. Here, we present the case of a patient with dental phobia who was successfully treated with these techniques. The patient was a 22-year-old woman with a history of manic-depressive illness who presented with 23 decayed teeth. She had previously undergone vital pulp therapy; however, post-treatment pain led to treatment-related stress, and the patient discontinued the dental treatment. She preferred the dental treatment to be completed with as little pain as possible and wanted to avoid a pulpectomy. The patient’s history of heavy use of non-steroidal anti-inflammatory drugs (NSAIDs) made her resistant to NSAIDs. As a result, the analgesic effect of NSAIDs could not be expected. After intravenous midazolam and propofol sedation, an ultrasound-guided inferior alveolar nerve block was performed bilaterally, and 0.375% ropivacaine was used as a local anesthetic. The patient did not complain of post-operative pain, and no post-operative analgesics were required.

Application of ultrasound guidance in the oral and maxillofacial nerve block

Introduction

Nerve block technology is widely used in clinical practice for pain management. Conventional nerve localization methods, which only rely on palpation to identify anatomical landmarks, require experienced surgeons and can be risky. Visualization technologies like ultrasound guidance can help prevent complications by helping surgeons locate anatomical structures in the surgical area and by guiding the operation using different kinds of images. There are several important and complex anatomical structures in the oral and maxillofacial regions. The current article reviews the application of ultrasound guidance in oral and maxillofacial nerve blocks.

Methods

We searched the literature on the use of ultrasound guidance for the main nerve block techniques in the oral and maxillofacial regions using both PubMed and MEDLINE and summarized the findings.

Results and Discussion

A review of the literature showed that ultrasound guidance improves the safety and effectiveness of several kinds of puncture procedures, including nerve blocks. There are two approaches to blocking the mandibular nerve: intraoral and extraoral. This review found that the role of ultrasound guidance is more important in the extraoral approach. There are also two approaches to the blocking of the maxillary nerve and the trigeminal ganglion under ultrasound guidance: the superazygomatic approach and the infrazygomatic approach. The infrazygomatic approach can be further divided into the anterior approach and the posterior approach. It is generally believed that the anterior approach is safer and more effective. This review found that the effectiveness and safety of most oral and maxillofacial nerve block operations can be improved through the use of ultrasound guidance.

Injectate spread in ultrasound-guided inferior alveolar nerve block: a cadaveric study

PURPOSE

Ultrasound-guided inferior alveolar nerve block (UGIANB) is a mandibular analgesic procedure in which local anesthetic is injected into the pterygomandibular space (PMS). Several studies have reported the clinical efficacy of UGIANB for mandibular surgeries; however, its effective range has never been investigated. We performed a cadaveric study to investigate the success rate of UGIANB injections and to determine whether injected dye could stain the mandibular nerve (MN) trunk and its branches.

METHODS

We performed UGIANB on the bilateral faces of 4 Thiel-embalmed cadavers. A needle was advanced to the PMS under ultrasound guidance and 5 mL of dye was injected. The cadaver was dissected and inspected for the presence of dye in the PMS; the range of dye spread to any of the inferior alveolar nerve (IAN), lingual nerve (LN), buccal nerve (BN), mandibular nerve (MN), auriculotemporal nerve (ATN), or facial nerves; and for the presence of intravascular dye.

RESULTS

We performed eight UGIANB procedures on four cadavers. Dye was observed in the PMS in 7/8 injections. Staining was observed in all IAN, LN, and BNs that could be identified at dissection. No MN or auriculotemporal nerves (ATNs) were stained in any injections. No intravascular dye was observed in any injections.

CONCLUSIONS

UGIANB can administer anesthetic into the PMS with high accuracy. UGIANB injections reached the IAN, LN, and BNs, but did not reach the MN or ATNs located outside the PMS. The findings of this cadaveric study indicate that UGIANB can provide sufficient analgesia for mandibular surgeries.

Ultrasound-Guided Local Anesthetic Nerve Blocks in a Forehead Flap Reconstructive Maxillofacial Procedure

Head and neck reconstructive surgery involving tissue flaps is often complex requiring the development of an individualized anesthetic plan. The following case report describes the anesthetic management of an 87-year-old man considered at high risk for postoperative delirium due to advanced age and blindness undergoing general anesthesia for resection of squamous cell carcinoma of the right side of the nose and reconstructive surgery with a scalping forehead flap. Ultrasound-guided local anesthetic maxillary and supraorbital nerve blocks were successfully used perioperatively to reduce the need for alternative analgesics associated with higher risks of complications such as postoperative nausea, vomiting, and delirium.

Ultrasound-guided inferior alveolar nerve block for trismus during dental treatment: a case report

Background

Temporomandibular disorder (TMD) is a broad term that encompasses pain and/or dysfunction of the masticatory musculature and TM joints (TMJs). When TMD becomes a chronic condition, the symptoms are extremely difficult to manage and require multiple interventions.

Case presentation

A woman in her 50s developed TMD after a traffic accident 30 years ago. The patient presented with severe trismus due to TMJ pain and a maximum mouth opening of 20 mm. Ultrasound-guided inferior alveolar nerve block (IANB) was performed with ropivacaine. After IANB, the pain during mouth opening subsided and the maximum mouth opening improved to 40 mm. Dental treatment could be performed without difficulty and the patient could keep her mouth open throughout the treatment.

Conclusions

Treatments for chronic TMD are limited and it is necessary to identify the precise etiology before choosing a treatment option. In this patient, ultrasound-guided IANB proved to be effective in relieving TMD-related trismus.