Suprazygomatic Access for Continuous Bilateral Mandibular Nerve Block for Pain and Trismus Relief in the Tetraplegic Patient

Referral to Pain Specialists for Treatment of Intractable Mandibular Pain Caused by Osteonecrosis of the Jaw: A Case Series Report

Pain is a problematic symptom in patients with osteonecrosis of the jaws (ONJ). Effective pain management in patients with advanced ONJ still remains an unresolved issue. This case series report presents three patients who were referred to the pain clinic for treatment of intractable pain caused by ONJ. Two patients received mandibular nerve blocks and achieved pain relief. After referral to the pain clinic, these two patients underwent segmental mandibulectomy for ONJ. In the third patient, the effect of pain control was limited. Appropriate cooperation between the oral and maxillofacial surgeon and the pain specialist is essential for pain management in patients with advanced ONJ who experience intense pain.

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.