Clinical anatomy of the maxillary nerve block in pediatric patients
Lané Prigge1, Albert-Neels van Schoor, Marius C Bosman
1Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Anatomy, School of Pathology and Pre-Clinical Sciences, Faculty of Health Sciences, University of Limpopo (Medunsa Campus), Ga-Rankuwa, South Africa.
Insights
The suprazygomatic approach (technique B) is the most consistent method for pediatric maxillary nerve blocks. This study compared three techniques in pediatric cadavers to determine the optimal approach for blocking the maxillary nerve.
Area of Science:
- Pediatric Anesthesiology
- Anatomical Dissection
- Regional Anesthesia
Background:
- Pediatric anatomical data is often extrapolated from adult studies.
- Maxillary nerve blocks are crucial for infant cleft palate repair analgesia.
- Optimal pediatric maxillary nerve block approaches require anatomical validation.
Purpose of the Study:
- To identify the most effective approach for pediatric maxillary nerve blocks within the pterygopalatine fossa.
- To compare three distinct needle insertion techniques for accuracy and consistency.
Main Methods:
- Three approaches (A, B, C) were simulated on 10 pediatric skulls and 30 pediatric cadavers.
- Needle trajectory, depth, and angles were measured for blocking the maxillary nerve at the foramen rotundum.
- Two age groups were studied: neonates (0-28 days) and infants (28 days-1 year).
Main Results:
- Technique B (suprazygomatic from frontozygomatic angle) showed no significant statistical differences in measurements.
- Techniques A (suprazygomatic from orbit midpoint) and C (infrazygomatic) exhibited significant variations.
- No significant differences were found between left and right sides in any tested specimen.
Conclusions:
- Technique B provides the most consistent anatomical data for pediatric maxillary nerve blocks across both studied age groups.
- These findings support recent clinical observations regarding the efficacy of technique B.
- The suprazygomatic approach (technique B) is recommended for pediatric maxillary nerve blocks.
Background:
Anatomical landmarks in children are mostly extrapolated from studies in adults. Despite this, complex regional anesthetic procedures are frequently performed on pediatric patients. Sophisticated imaging techniques are available but the exact position, course and/or relationships of the structures are best understood with appropriate anatomical dissections. Maxillary nerve blocks are being used for peri-operative analgesia after cleft palate repair in infants. However, the best approach for blocking the maxillary nerve in pediatric patients has yet to be established.
Objective:
To determine the best approach for blocking the maxillary nerve within the pterygopalatine fossa.
Methods:
In an attempt to define an optimal approach for maxillary nerve block in this age group three approaches were simulated and compared on 10 dried pediatric skulls as well as 30 dissected pediatric cadavers. The needle course, including depth and angles, to block the maxillary nerve, as it exits the skull at the foramen rotundum within the pterygopalatine fossa, was measured and compared. Two groups were studied: Group 1 consisted of skulls and cadavers of neonates (0-28 days after birth) and Group 2 consisted of skulls and cadavers from 28 days to 1 year after birth.
Results:
No statistically significant difference (P > 0.05) was found between the left and right side of each skull or cadaver. Only technique B, the suprazygomatic approach from the frontozygomatic angle towards the pterygopalatine fossa, exhibited no statistical significance (P > 0.05) when other measurements made on the skulls and cadavers were compared. Technique A, a suprazygomatic approach from the midpoint on the lateral border of the orbit, as well as technique C, an infrazygomatic approach with an entry at a point on a vertical line extending along the lateral orbit wall, showed statistical significant differences when measurements of the skulls and cadavers were compared.
Conclusions:
On the basis of these findings technique B produces the most consistent data for age groups 1 and 2 and supports the clinical findings recently reported.
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