title: Anatomical landmarks for maxillary nerve block in the pterygopalatine fossa: A radiological study.
abstract: BACKGROUND
  The aim of this study was to describe the anatomical landmarks for maxillary nerve block in the pterygopalatine fossa. The risk of injury to the skull base and maxillary artery was assessed.
  
  
  METHODS
  This retrospective study was based on the analysis of 61 consecutive computed tomography angiographies obtained from patients suffering from different pathologies. Anatomical relationships between optic canal (OC), foramen rotundum (FR), inferior orbital fissure (IOF) and puncture point (PP) were assessed. A "maxillary section" was virtually carried out on the CTs, following a plane passing through PP, IOF and FR in order to mimic the anaesthesia needle route.
  
  
  RESULTS
  No gender difference was observed except for the PP-OC distance that was longer in men. The mean PP-IOF distance was of 31.9 (± 0.7mm). PP-OC (43.9±0.5) and PP-FR (44.2±0.7) distances increased significantly with the patients height (PP-FR=17.25+0.16×height (cm); PP-OC=20.54+0.13×height (cm)). The route to the skull base was curved, with an angle of 168±1.6° at the FR level. The angle to reach the OC was greater than 7°.
  
  
  CONCLUSIONS
  With a 35-mm needle length, the probability to reach the IOF was high (79%), while the risk to injure the skull base (2%) and the optical nerve (0%) was low. Artery injuries were only found in 13% of cases. Therefore, a 35-mm needle length allows for the best efficacy/risk ratio in maxillary nerve block.
authors.affiliation: Department of maxillofacial surgery, University hospital Pellegrin, place Amélie-Raba-Léon 33076 Bordeaux, France. Electronic address: carrier.stephanie@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Carrier
authors.affiliation: BIOGECO, INRA, University of Bordeaux, 33600 Cestas, France.
authors.forename: B
authors.initials: B
authors.lastname: Castagneyrol
authors.affiliation: Department of anaesthesia SAR-3, University hospital Pellegrin, 33076 Bordeaux, France.
authors.forename: L
authors.initials: L
authors.lastname: Beylacq
authors.affiliation: Department of anaesthesia SAR-3, University hospital Pellegrin, 33076 Bordeaux, France.
authors.forename: K
authors.initials: K
authors.lastname: Nouette-Gaulain
authors.affiliation: Department of radiology, University hospital Haut-Lévêque, 33604 Pessac, France.
authors.forename: M
authors.initials: M
authors.lastname: Montaudon
authors.affiliation: Department of maxillofacial surgery, University hospital Pellegrin, place Amélie-Raba-Léon 33076 Bordeaux, France; Laboratory of applied surgical and medical anatomy, University of Bordeaux, 33076 Bordeaux, France.
authors.forename: M
authors.initials: M
authors.lastname: Laurentjoye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks / Q000000981:diagnostic imaging* / Q000473:pathology; D000765:Anesthesia, Conduction; D000072226:Computed Tomography Angiography; D005260:Female; D005602:France; D006801:Humans; D007267:Injections; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000473:pathology; D008442:Maxillary Nerve / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000473:pathology; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009915:Orbit / Q000000981:diagnostic imaging / Q000473:pathology; D056739:Pterygopalatine Fossa / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D019291:Skull Base / Q000000981:diagnostic imaging / Q000473:pathology; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D055815:Young Adult
keywords: Imaging study; Maxillary nerve; Pterygopalatine fossa