Ultrasound-Guided Mandibular Nerve Block in the Infratemporal Fossa for Awake Craniotomy: A Cadaveric Feasibility
Miguel Mayol Del Valle1, Natasha Frontera2, Adriana Vazquez-Medina1
1Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI.
Cureus
|August 4, 2026
Summary
This study explored ultrasound-guided anesthesia for the trigeminal nerve (V3) in cadavers to improve awake craniotomies. Findings suggest a novel technique for enhanced scalp blocks during neurosurgery.
Area of Science:
- Neurosurgery
- Anesthesiology
- Anatomy
Background:
- Awake craniotomies require effective analgesia for preserving eloquent brain areas.
- Traditional scalp blocks target six specific nerves.
- Trigeminal nerve branch blocks offer adjunctive anesthesia for awake craniotomies.
Purpose of the Study:
- To investigate a novel ultrasound-guided local anesthesia technique for the mandibular branch of the trigeminal nerve (V3).
- To assess the feasibility of targeting V3 anesthesia via the infratemporal fossa (ITF) using ultrasound guidance.
Main Methods:
- Four adult cadaveric specimens were utilized.
- Dissection of the infratemporal fossa (ITF) was performed in two specimens.
- Ultrasound-guided methylene blue dye injections were administered into the ITF in two specimens, targeting specific fascial planes.
- Injection sites were confirmed via dissection and dye visualization.
Main Results:
- Ultrasound-guided injections placed deep in the ITF, between the periosteum and lateral pterygoid fascia, showed dye distribution.
- Dye reached the V3 entrance at the foramen ovale.
- This technique demonstrated potential for local anesthesia distribution within the ITF.
Conclusions:
- Ultrasound-guided injection into the ITF is a promising novel technique for V3 anesthesia.
- This approach could enhance scalp blocks for awake craniotomies.
- Further clinical studies are necessary to validate efficacy and safety.
