Background and objective Trigeminal neuralgia (TN) is a debilitating disorder characterized by acute episodic attacks of pain that significantly impair patients\' quality of life and overall functioning. Initial therapeutic strategies to treat this condition include pharmacological options, particularly carbamazepine. In cases with resistance to dose escalation and polypharmacy, interventional procedures may be warranted. The primary aim of this study was to compare the efficacy of trigeminal ganglion (TG) radiofrequency thermocoagulation (RFT) and ultrasound (US)-guided maxillary/mandibular (max/mand) nerve pulsed radiofrequency (PRF) for treating TN, based on the findings at six months post-treatment. The secondary aims were to assess the impact of these interventions on drug consumption and interventional safety based on adverse events. Methods This prospective, randomized, single-blind study was conducted at a single pain clinic. Forty-four patients were randomized into two groups. Group RFT received TG RFT at 60 °C, 65 °C, and 70 °C for 60 seconds each, whereas Group PRF received max/mand PRF for 240 seconds. Pain relief was assessed by using the numeric rating scale (NRS) and intervention effectiveness on medication consumption was evaluated by using the Medication Quantification Scale III (MQS III). The rates of intervention-related adverse events were also compared. Results Both RFT and PRF significantly alleviated pain at one and six months post-treatment compared to baseline (p<0.05). No statistical differences were found in the NRS and MQS III scores between the groups. At six months, 77.3% of RFT patients and 63.9% of PRF patients experienced at least 50% pain relief, with no statistically significant difference. Hypoesthesia occurred in two RFT patients, and masseter weakness was observed in one patient, while no adverse events were reported in the PRF group. Conclusions TG RFT and max/mand PRF are effective treatments for TN. US-guided max/mand PRF, which avoids RFT-associated complications and radiation exposure, may be the superior and preferable option. In this study, the potential space between the coronoid process and maxilla was used to access the maxillary nerve during the maxillary block and PRF procedures, in contrast to the classical approach through the mandibular notch. Further large-scale randomized controlled trials are required to gain deeper insights into the topic.

BACKGROUND: Although the maxillary nerve block (MNB) provides adequate pain relief in cleft palate surgery, it is not routinely used globally, and reported techniques are heterogeneous. This study aims to describe relevant anatomy and to present the preferred technique of MNB administration based on the current literature and the expert opinion of the authors.
METHODS: First, a survey was sent to 432 registrants of the International Cleft Palate Master Course Amsterdam 2023. Second, MEDLINE (PubMed interface) was searched for relevant literature on maxillary artery (MA) anatomy and MNB administration in pediatric patients.
RESULTS: Survey response rate was 18% (n=78). Thirty-five respondents (44.9%) used MNB for cleft palate surgery before the course. A suprazygomatic approach with needle reorientation towards the ipsilateral commissure before incision was most frequently reported, mostly without the use of ultrasound. Ten and 20 articles were included on, respectively, MA anatomy and MNB administration. A 47.5% to 69.4% of the MA\'s run superficial to the lateral pterygoid muscle and 32% to 52.5% medially. The most frequently described technique for MNB administration is the suprazygomatic approach. Reorientation of the needle towards the anterior aspect of the contralateral tragus appears optimal. Needle reorientation angles do not have to be adjusted for age, unlike needle depth. The preferred anesthetics are either ropivacaine or (levo)bupivacaine, with dexmedetomidine as an adjuvant.
CONCLUSIONS: Described MNB techniques are heterogeneous throughout the literature and among survey respondents and not routinely used. Further research is required comparing different techniques regarding efficacy and safety.

A 20-year-old quarter horse gelding was presented for routine dental examination. Periodontal disease and luxation of tooth 108 was diagnosed and oral extraction was planned. After an unsuccessful blind maxillary nerve block, it was elected to perform the procedure under total intravenous anesthesia. Following recovery, a focal superficial corneal ulcer, severe retrobulbar swelling, mild exophthalmos, and marked swelling and prolapse of the third eyelid (nictitating membrane) were observed. Clinical signs persisted beyond 48 h despite the use of systemic anti-inflammatories and topical ocular anti-inflammatories and antibiotics. A temporary tarsorrhaphy was subsequently done at 48 h and the horse was discharged after 5 d of hospitalization and regression of clinical signs. Although it is very useful for easing dental extractions, the blind maxillary nerve block is associated with potential complications due to inadvertent vascular puncture. This case report describes a rare complication of prolapse of the third eyelid in a horse after a maxillary nerve block and successful treatment with a temporary tarsorrhaphy. Key clinical message: This case report explains how nictitating membrane swelling and prolapse can occur following a blind maxillary nerve block in the horse and describes treatment with a temporary tarsorrhaphy.
Hématome orbitaire sévère avec gonflement de la troisième paupière et prolapsus à la suite d’un bloc du nerf maxillaire à l’aveugle chez un cheval. Un hongre quarter horse de 20 ans a été présenté pour un examen dentaire de routine. Une maladie parodontale et une luxation de la dent 108 ont été diagnostiquées et une extraction orale a été planifiée. Après l’échec d’un bloc du nerf maxillaire à l’aveugle, il a été décidé d’effectuer la procédure sous anesthésie intraveineuse. Après la guérison, un ulcère cornéen superficiel focal, un gonflement rétrobulbaire sévère, une légère exophtalmie ainsi qu’un gonflement et un prolapsus marqués de la troisième paupière (membrane nictitante) ont été observés. Les signes cliniques ont persisté au-delà de 48 heures malgré l’utilisation d’anti-inflammatoires systémiques et d’anti-inflammatoires oculaires topiques et d’antibiotiques. Une tarsorraphie temporaire a ensuite été réalisée à 48 heures et le cheval est sorti après 5 jours d’hospitalisation et de régression des signes cliniques. Bien qu’il soit très utile pour faciliter les extractions dentaires, le bloc du nerf maxillaire à l’aveugle est associé à des complications potentielles dues à une ponction vasculaire involontaire. Ce rapport de cas décrit une complication rare de prolapsus de la troisième paupière chez un cheval après un bloc nerveux maxillaire et un traitement réussi par tarsorraphie temporaire.Message clinique clé:Ce rapport de cas explique comment un gonflement et un prolapsus de la membrane nictitante peuvent survenir à la suite d’un bloc du nerf maxillaire à l’aveugle chez le cheval et décrit le traitement par tarsorraphie temporaire.(Traduit par Dr Serge Messier).

Experimental maxillofacial surgery is commonly performed in pigs; however, locoregional anesthesia of this area has not been described. This study evaluated the feasibility of a novel maxillary nerve block approach. In part I, cadavers were used to determine anatomic landmarks and assess maxillary nerve dye staining by using 0.03 mL kg-1 of a 1:10 mixture of commercial food dye and 0.5% bupivacaine. In part II, 10 additional pig cadavers underwent bilateral ultrasound-guided maxillary nerve blocks by using trans-infraorbital canal needle placement. The maxillary nerve was harvested and scored based on degree of staining (0 and 1, absent or incomplete staining; 2, staining; >1 cm circumferentially). Intracranial and intraconal spread of dye was evaluated. A Kruskal-Wallis test was used to compare infraorbital canal length estimated either externally via landmarks, internally via ultrasound, or actually measured after dissection. In 18 of 20 (90%) injections, successful staining (score = 2) of maxillary nerves was obtained for a nerve length of 2.4 ± 0.3 cm. Two of 20 cases (10%) had inadequate staining (score <2). At dissection of these 2 cases, the needle tip was observed to have collided with an unerupted tooth (third molar). No intracranial or intraconal spread of dye was observed. We detected no statistical differences between the estimated external, estimated internal, or actual dissection methods for measurement of infraorbital canal length (P = 0.3). Ultrasound-guided trans-infraorbital maxillary nerve block in pigs is a feasible technique, warranting further work to evaluate its in vivo efficacy and safety.

The infraorbital nerve is responsible for the sensory innervation of the lower eyelid, the lateral nose, the cheek, the upper lip, and the maxillary teeth. It passes along the infraorbital canal, which runs superior to the maxillary sinus. Dehiscence of the infraorbital canal and its ectopic course in the maxillary sinus is a rare variation. A nerve with these variations may be affected by pathologies in the maxillary sinus and this may constitute a rare cause of facial pain. In this report, we present the clinical symptoms of a 29-year-old male patient who had an infraorbital nerve with an ectopic course and dehiscence in light of the literature.

Introduction Due to the variable degree of pneumatization, the shape and size of the sphenoid sinus are irregular. An endoscopic intranasal transsphenoidal approach is made in sphenoid sinus pathologies, sphenoid sinusitis, and sellar and parasellar diseases. A diagnostic approach to the sphenoid sinus is also done to get a better MRI scan of the pituitary. The present study aims to describe the variant types of sphenoid sinus, morphometry, anatomy, and relations of sphenoid sinus, which will be helpful to surgeons during an endoscopic approach to the sphenoid sinus. Materials and methods We studied 76 cadaveric sphenoid sinuses that were exposed by taking a sagittal section of 38 formalin-fixed cadaveric heads. After examining the inter-sphenoidal septum, it was removed to observe the inside aspect of the sphenoid sinus. Different dimensions of the sinus were noted down. The bulges inside the sinus due to neurovascular structures in relation to the sinus were observed. Results  The most prominent type found was the sellar in 68.4% of cases preceded by the postsellar in 23.7% of cases. Presellar type of pneumatization was seen only in 7.9% of cases and the conchal type was absent. Intersphenoid septum was seen in 92,1% of cases, out of which 11.4% of septums were deficient on the posterior aspect. An internal carotid artery bulge in the sphenoid sinus was seen in 46% of cases. In 27.6% and 19.7% of sphenoid sinuses, bulging of the optic and vidian nerves, respectively, were seen. Some of these structures were dehiscent in the sphenoid sinus. Conclusions To get more space in the sphenoid sinus, the septa in the sinus are removed by surgeons, which may damage the walls of the sphenoid sinus. Knowledge of the relations of neurovascular structures with the sphenoid sinus will be helpful to surgeons during the transsphenoidal endoscopic approach to avoid any injury to these structures.

We report a case of ultrasound-guided craniocervical nerve blocks performed with ropivacaine for perioperative local/regional anesthesia in a patient who underwent right partial maxillary resection and neck dissection under general anesthesia. The patient was an 85-year-old woman with multiple medical comorbidities in whom analgesia using nonsteroidal anti-inflammatory drugs and opioids was expected to increase the risk of postoperative complications. Bilateral ultrasound-guided maxillary (V2) nerve blocks and a right superficial cervical plexus block were performed, which provided adequate perioperative anesthesia and avoided postoperative complications. The use of ultrasound-guided craniocervical nerve blocks with ropivacaine can be an effective approach for providing prolonged perioperative local anesthesia and analgesia, minimizing the need for other potentially problematic analgesics.

OBJECTIVE: The palatine bone (PAL) rides over the maxilla (MX) without an end-to-end suture in the bony palate of fetuses. However, changes in the topographical relationship among bones was unknown at and along the pterygopalatomaxillary suture, including the palatine canals.
METHODS: Using sagittal, frontal, and horizontal histological sections of the head from 15 midterm fetuses to 12 near-term fetuses, we depicted the changes in the topographical anatomy of the MX, PAL, and greater palatine nerve (GPN).
RESULTS: In the bony greater palatine canal of these fetuses, the medial and posterior walls facing the GPN were consistently made up of the PAL. At midterm, the entire course of the GPN was embedded in the PAL (six fetuses), or the MX contributed to the lateral wall of the nerve canal (nine). At near-term, the anterior and lateral walls showed individual variations: an MX in the anterior and lateral walls (three fetuses), an anterior MX and a lateral PAL (five), an anterior PAL and a lateral MX (two), and a PAL surrounding the GPN (four).
CONCLUSIONS: These increasing variations suggested that the pterygopalatomaxillary suture was actually growing and that the PAL transiently expanded anteriorly and/or laterally to push the MX in fetuses. The \"usual\" morphology in which the GPN is sandwiched by the MX and PAL is likely established after birth, possibly during adolescence. The driving force of this change may not be produced by the masticatory apparatus. Rather, it might be triggered by the growing maxillary sinus.

UNASSIGNED: The aim of this study was to investigate the prevalence of infraorbital canal protrusion in an Egyptian subpopulation using cone-beam computed tomography and to describe its radiographic representation.
UNASSIGNED: This retrospective cross-sectional study was conducted using the records of 77 patients and 123 maxillary sinuses. The full lengths of the sinuses were visible for the detection of infraorbital canal protrusion. The infraorbital canals were classified into 3 types based on their relation to the sinus. If the septum was present, its length and its distance from the sinus floor were measured. Qualitative and quantitative variables were described as percentages and means with standard deviations, respectively.
UNASSIGNED: The infraorbital canal most commonly presented as the normal confined type (detected in 78.1% of sinuses), whereas the suspended (or protruded) variant was found in 14.6% of the examined sinuses. The septal length ranged from 0.9 to 5.1 mm, with a mean of 2.8±1.1 mm. The distance to the sinus floor ranged from 5.2 to 29.6 mm depending on the sinus shape and size.
UNASSIGNED: The present study indicates that protrusion of the infraorbital canal is not rare, and surgeons that use the maxillary sinuses as corridors for their procedures must be more cautious, especially in the upper lateral confines of the sinus.

This retrospective study assessed the effect of an intraoral bilateral maxillary nerve block in dogs undergoing surgery for brachycephalic obstructive airway syndrome (BOAS). Records of dogs that underwent BOAS surgery were retrieved. Cases were assigned to Group B or C if a preoperative bilateral maxillary nerve block was performed or not. Type and dose of local anesthetic, inhalant anesthetic minimum alveolar concentration multiples, intraoperative fentanyl and injectable anesthetic use, prevalence of intraoperative hypotension or bradycardia, and postoperative opioids administration, were compared between groups. Sixty-seven cases met the inclusion criteria: 33 were assigned to Group B and 34 to Group C. In Group C, 18 dogs required intraoperative fentanyl (P = 0.005), and 12 needed injectable anesthetic top-ups (P = 0.006). Hypotension, or bradycardia, were not different between groups. Bilateral maxillary nerve block reduces intraoperative fentanyl and injectable anesthetic requirement in dogs undergoing BOAS surgery.
Évaluation du bloc nerveux maxillaire bilatéral chez les chiens brachycéphales opérés pour un syndrome obstructif des voies respiratoires. Cette étude rétrospective a évalué l’effet d’un bloc nerveux maxillaire intra-oral bilatéral chez des chiens brachycéphales subissant une intervention chirurgicale pour le syndrome obstructif des voies respiratoires (BOAS). Les dossiers des chiens qui ont subi une chirurgie BOAS ont été récupérés. Les cas ont été classés dans le groupe B ou C si un bloc du nerf maxillaire bilatéral préopératoire était réalisé ou non. Le type et la dose d’anesthésique local, les multiples de concentration alvéolaire minimale d’anesthésique par inhalation, l’utilisation peropératoire de fentanyl et d’anesthésiques injectables, la prévalence de l’hypotension ou de la bradycardie peropératoire et l’administration postopératoire d’opioïdes ont été comparés entre les groupes. Soixante-sept cas répondaient aux critères d’inclusion : 33 ont été affectés au groupe B et 34 au groupe C. Dans le groupe C, 18 chiens ont eu besoin de fentanyl peropératoire (P = 0,005) et 12 ont eu besoin de compléments anesthésiques injectables (P = 0,006). L’hypotension ou la bradycardie n’étaient pas différentes entre les groupes. Le bloc nerveux maxillaire bilatéral réduit les besoins peropératoires en fentanyl et en anesthésique injectable chez les chiens subissant une chirurgie BOAS.(Traduit par Dr Serge Messier).