Suprazygomatic Access for Continuous Bilateral Mandibular Nerve Block for Pain and Trismus Relief in the Tetraplegic Patient.

PURPOSE: Extraoral mandibular nerve block (MNB) is used in oropharyngeal surgery for analgesia and anesthesia. Repeated or continuous MNB has been used successfully as treatment for uncontrollable pain, masseter spasticity, and airway assessment. The usual technique involves transcutaneous infrazygomatic access. However, in some specific settings, this approach is not always feasible.

MATERIALS AND METHODS: A continuous bilateral MNB with a suprazygomatic approach to the pterygomandibular space was used to resolve a case of refractory and painful trismus in a patient with tetraplegia.

RESULTS: Analgesia was achieved and maintained by bilateral catheter placement to the pterygomandibular space and repeated injection of local anesthetic for 48 hours. The right-side catheter was accidentally withdrawn; the left-side catheter was maintained up to 72 hours. The efficiency of analgesia was not affected. This block provided effective analgesia within the first few hours after local anesthetic injection, helped to improve mouth opening, and resolved acute pain. Because kinesitherapy could be introduced, the patient was left on nonopioid analgesics.

CONCLUSION: Continuous bilateral MNB through the suprazygomatic approach was used safely and efficiently. The suggested approach is quite unique, as is the clinical circumstance, and might be considered when the usual technique is challenging.