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Regional anesthetic techniques have a well established role in head and neck surgery. Successful anesthesia and analgesia for a number of procedures can be accomplished with the proper application of these techniques. For example, regional blocks can be utilized during procedures such as endoscopic sinus surgery, facial plastic surgery, thyroidectomy, and parathyroidectomy surgery. Various ear nose and throat procedures are increasingly being performed in an office-based setting. These are often done using topical anesthesia of the airway or regional blockade. Because of the close proximity of many nerve and vascular structures in this region, practitioners should be familiar with possible complications of these techniques and means to prevent and treat them. This chapter will review the anatomy relevant to regional blocks of the head and neck and will highlight examples for use of each technique in current practice. Additional discussion on numerous regional anesthesia techniques and their application can be also found in Chapter 19 (Airway Blocks) and in Chapters 20 (Oral and Maxillofacial Regional Anesthesia) and 55 (Regional and Local Anesthesia in Pediatric General Dentistry). To avoid redundancy, this chapter will deal only with the anatomic and block techniques not covered in the aforementioned chapters.

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Indications

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Gasserian ganglion block is used primarily for treatment of trigeminal neuralgia, a relatively rare but devastating form of neuropathic facial pain.1–3 Patients with trigeminal neuralgia typically present with the spontaneous onset of pain in one or more divisions of the trigeminal nerve. The most common presentation involves both V2 and V3; however, any or all divisions may be involved. Patients report paroxysmal lancinating pain in the face that is often severe. The pain usually has a specific area of trigger—pressure on this trigger area elicits the pain.4 Patients who present with new symptoms suggestive of trigeminal neuralgia should undergo a thorough neurologic evaluation, including imaging studies to rule out intracranial pathology. The majority of patients with trigeminal neuralgia will respond to oral neuropathic medications; carbamezapine remains the agent of choice.4,5 Neural blockade is usually reserved for those with trigeminal neuralgia that do not respond to pharmacologic therapy.1,6 Local anesthetic block of the trigeminal ganglion and its primary divisions is often used as a diagnostic test to predict response to neural blockade prior to proceeding with neurolysis.7–9

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Clinical Pearls
  • Neural blockade of the trigeminal ganglion is usually reserved for those with trigeminal neuralgia that do not respond to pharmacologic therapy.
  • Local anesthetic block of the trigeminal ganglion and its primary divisions is often used as a diagnostic test to predict response to neural blockade prior to proceeding with neurolysis.
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Anatomy

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The trigeminal nerve, the fifth cranial nerve, supplies the majority of sensory innervation to the face (Figure 18–1). Preganglionic fibers exit the brainstem and travel anteriorly to synapse with second-order neurons within the trigeminal (gasserian) ...

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