Ultrasound-guided lateral pterygoid muscle injection for inferior alveolar nerve block in sagittal split ramus osteotomy: a three-case series

TL;DR

A new ultrasound-guided injection technique targeting the lateral pterygoid muscle provides effective pain control after a specific jaw surgery.

Contribution

A novel ultrasound-guided lateral pterygoid muscle injection technique for regional anesthesia during jaw surgery.

Findings

All three patients had excellent postoperative pain control with numerical rating scale scores ≤ 2.

The technique required minimal analgesic use and no complications.

The method offers a simplified, opioid-free approach for postoperative pain management.

Abstract

Sagittal split ramus osteotomy is often associated with significant postoperative pain. Intraoral inferior alveolar nerve blocks have variable success rates and higher risks of vascular complications, while ultrasound-guided approaches to the pterygomandibular space require precise needle placement in a narrow anatomical space. We present a novel perioperative application of ultrasound-guided lateral pterygoid muscle injection for regional anesthesia.

Three female patients underwent bilateral sagittal split ramus osteotomy under general anesthesia. After anesthesia induction, ultrasound-guided lateral pterygoid muscle injections were performed using 10 mL of 0.25% levobupivacaine. All patients demonstrated excellent postoperative pain control (numerical rating scale score ≤ 2) with minimal analgesic requirements and no complications.

This novel lateral pterygoid muscle injection technique for perioperative analgesia demonstrates promising clinical efficacy through a simplified ultrasound-guided approach, providing effective opioid-free postoperative pain management for sagittal split ramus osteotomy.

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