Anesthesia (15)

Use of computed tomography for maxillary nerve block in the treatment of trigeminal neuralgia. (Dokkyo University School of Medicine, Mibu, Tochigi, Japan) Reg Anesth Pain Med 2000;25:417–419.
A report of a 90-year-old woman who had a 30-year history of episodic pain in her right maxillary region is presented. An attempt to block the nerve with classic technique was made, but eliciting paresthesia could not identify the nerve. In addition, bleeding was noted after repeated attempts. To minimize complications and confirm the correct position of the needle tip, the block was planned with a suprazygomatic approach using computed tomography (CT) guidance. The needle was inserted without paresthesia. The CT scan showed the needle tip was placed at the entrance of the pterygopalatine fossa and the distribution of contrast medium spread appropriately around the pterygopalatine fossa. After confirming the clinical effect and lack of complications of the block using the local anesthetic, 0.5 mL of 7% phenol was injected. The technique resulted in complete sensory loss in the area innervated by the maxillary nerve and did so without complications.
Comment by Andrew D. Rosenberg, MD.
This is an interesting article in which the authors describe their technique for treating trigeminal neuralgia. The authors were faced with a significant problem, which was to perform a maxillary nerve block in a patient with difficult anatomy. The approach and technique were clearly thought out with an excellent result. The axial cuts demonstrate needle position under CT scan and the appropriate spread of contrast material through the pterygopalatine fossa.