Presented at the 2012 AAPM Annual Meeting « Back

Ultrasound-Guided Injection for Superficial Trigeminal Nerve Block

David Spinner, DO, dspinnerny@aol.com, Mount Sinai Hospital, New York, New York

Introduction/Statement of the Problem: The purpose of this investigation was to describe a technique and assess accuracy for sonographically guided supraorbital, infraorbital, and mental nerve injections in a cadaveric model. Prior studies have shown peripheral trigeminal nerve injections can provide a treatment benefit for a subgroup of patients for whom surgical treatments are not appropriate. The accuracy of such an injection is necessary to limit side effects of the chosen injectate solution and improve its efficacy. Ultrasound guidance may improve the accuracy of an injection that is typically performed with a blind technique. Materials and Methods: A single operator completed 18 sonographically guided injections on six embalmed cadavers. Three cadavers were injected with a long axis approach and three cadavers were injected with a short axis approach. All injections were completed with methylene blue dye. Accuracy was based on accurate with overflow or inaccurate (no dye stained the target nerve). For statistical analysis, all injections staining the target nerve were considered "accurate," whereas "inaccurate" injections resulted in no nerve staining. Results: The accuracy rate was 89% (8 of 9) for the short axis approach and 100% (9 of 9) for the long axis approach. Seventeen injections were considered accurate with overflow and one injection was inaccurate. Conclusions: This cadaveric investigation suggests that sonographic guidance can be used to inject the peripheral trigeminal nerve with a high degree of accuracy. Clinicians should consider using sonographic guidance to inject the trigeminal nerve for diagnostic or therapeutic purposes when clinically indicated. References: 1)Is peripheral alcohol injection of value in the treatment of trigeminal neuralgia? An analysis of 100 cases. S. A. Shah. International Journal of Oral and Maxillofacial Surgery. 2010. 2)Ultrasound imaging to localize foramina for superficial trigeminal nerve block. Ban C.H. Tsui. Canadian Journal of Anesthesiology. (2009) 56:704-706 3)Trigeminal neuralgia: for one nerve a multitude of treatments. Cheshire WP. Expert Review Neurotherapeutics 7(11). (2007)

Funding: None