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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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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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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 ...