# 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.

## Key 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.