ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 41 of 68
УЖМБС 2021, 6(5): 294–301

Optimization of Local Anesthesia during Radical Maxillary Sinusotomy in Dental Patients

Mokryk O. Ya. 1, Putʹko Z. P. 2, Hychka A. M. 1,2, Zaharkiv A. M. 2

The purpose of the study was to give a clinical evaluation of the effectiveness of endonasal blockade of the nasopalatine nerve in different ways during radical maxillary sinusotomy in dental patients. Materials and methods. Clinical observations were performed in 50 patients diagnosed with chronic odontogenic maxillary sinusitis. Radical maxillary sinusotomy was performed under local potentiated anesthesia. All patients underwent anesthesia on the maxilla according to classical methods. Patients, depending on the methods of endonasal blockade of the nasopalatine nerve, were divided into two clinical groups: the main (24 people) and the comparison group (26 people). Patients of the main group underwent endonasal blockade of the nasopalatine nerve at the site of its branch from the pterygopalatine ganglion. In patients of the comparison group, the blockade of this nerve was performed before its entry into the incisal canal. The effectiveness of anesthesia was evaluated for clinical and autonomic manifestations of pain stress. Results and discussion. During the removal of polyps and pathological granulations from the mucous membrane of the maxillary sinus in patients of the main group there was no pain, no emotional-motor and autonomic manifestations of pain stress, which confirmed the effectiveness of the endonasal method of anesthesia of the nasopalatine nerve. In patients of the comparison group during similar surgical manipulations the full effect of local anesthesia was achieved in 50.0% of cases (χ2 – 8.065, р = 0.005). These were patients who had hypopneumatized or moderately pneumatized types of maxillary sinuses. The rest of the patients during the operation had emotional – motor and autonomic manifestations of pain stress during the removal of pathologically altered mucous membrane located on the medial wall of the maxillary sinus. Conclusion. Complete anesthesia of the mucous membrane, maxillary sinus, regardless of the degree of its pneumatization is achieved during the usage of endonasal blockade of the nasopalatine nerve at the site of its branch from the pterygopalatine ganglion during radical maxillary sinusotomy in dental patients. Anesthesia of the nasopalatine nerve in the lower nasal passage, before its entry into the incisal canal, allows painless surgery only in patients with hypopneumatized maxillary sinuses and in most patients with moderate pneumatization

Keywords: chronic maxillary sinusitis, maxillary sinusotomy, maxillary sinus, nasopalatine nerve, endonasal anesthesia, pain stress

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  1. Gadve VR, Shenoi R, Vats V, Shrivastava A. Evaluation of anxiety, pain, and hemodynamic changes during surgical removal of lower third molar under local anesthesia. Ann Maxillofac Surg. 2018;8:247-53.
  2. Sharma A, Pant R, Priyadarshi S, Agarwal N, Tripathi S, Chaudhary M. Cardiovascular changes due to dental anxiety during local anesthesia injection for extraction. J Maxillofac Oral Surg. 2019;18(1):80-7.
  3. Tarazona-Álvarez P, Pellicer-Chover H, Tarazona-Álvarez B, Peñarrocha-Oltra D, Peñarrocha-Diago M. Hemodynamic variations and anxiety during the surgical extraction of impacted lower third molars. J Clin Exp Dent. 2019;11(1):27-32.
  4. Pani SC, Al Garni B, Al Zain LM, Al Qahtani NS. Assessment of the impact of stress and anxiety on pain perception in patients undergoing surgery for placement of their first dental implant. Oral Health Dent Manag. 2014;13(2):464-8.
  5. López-Jornet P, Camacho-Alonso F, Sanchez-Siles M. Assessment of general pre and postoperative anxiety in patients undergoing tooth extraction: A prospective study. Br J Oral Maxillofac Surg. 2014;52:18-23.
  6. Araújo RZ, Pintor Junior AAC, Sigua-Rodriguez EA, Olate S, Alves LCF, de Castro WH. Pain control in third molar surgery. Int J Odontostomat. 2016;10(3):385-391.
  7. Eroglu CN, Ataoğlu H, Küçük K. Factors affecting anxiety-fear of surgical procedures in dentistry. Niger J Clin Pract. 2017;20:409-14.
  8. Mufti N, Mufti S, Mufti K. Stress and Anxiety in Patients undergoing Dental Extraction. Int J Oral Care Res. 2017;5(1):75-7.
  9. Kanakaraj M, Shanmugasundaram N, Chandramohan M, Kannan R, Mahendra Peruma S, Nagendran J. Regional anesthesia in faciomaxillary and oral surgery. J Pharm Bioallied Sci. 2012 Aug; 4(Suppl 2):264 -9.
  10. Vargas BA, Astorga P, Rioseco T. Anatomy applied to block anesthesia for maxillofacial surgery. Dental anatomy, Bağdagül Helvacioğlu Kivanç, IntechOpen; 2017.
  11. Velasco I, Vahdani S, Nuñez N, Ramos H. Large recurrent radicular cyst in maxillary sinus: A case report. Int J Odontostomat. 2017;11(1):101-5.
  12. Chybicki D, Lipczyńska-Lewandowska M, Ratajek-Gruda M, Janas-Naze A. Massive radicular cyst in the maxillary sinus as a result of deciduous molar tooth pulp necrosis. Case Rep Dent. 2020 Aug 4;2020:8837706.
  13. Nilesh K, Dadhich A. Unusually large radicular cyst presenting in the maxillary sinus. BMJ Case Rep. 2020;13:e236582.
  14. Shamil E, Rouhani M J, Basetti S, Bast F, Hopkins C, Surda P. Role of local anaesthetic nerve block in endoscopic sinus surgery: A systematic review and meta-analysis. Clin Otolaryngol. 2018 Oct;43(5):1201-8.
  15. Cavarra F, Tricarico G, Tepedino M, Alhadethi H, Brucoli M, Boffano P, Rocchetti V. Voluminous maxillary radicular cysts removal under local anesthesia. Minerva Stomatologica. 2019 Aug; 68(4):213-6.
  16. Decker J R, Dutton J M. Local anesthesia for nasal and sinus surgery. Ear Nose Throat J. 2013 Mar; 92(3):107-8.
  17. Shamil E, Casselden E, Bast F, Whiteley W, Hopkins Cl, Surda P. Role of local anaesthetic nerve block in patients undergoing endonasal surgery - our experience of 48 patients. Rhinology Online. 2018 Aug; 1:90-3.
  18. Scott GM, Diamond Ch, Micomonaco DC. Assessment of a lateral nasal wall block technique for endoscopic sinus surgery under local anesthesia. Am J Rhinol Allergy. 2018 Jul;32(4):318-322.
  19. Hu YK, Yang Ch, Xu GZh, Xie QY. Digital design of functional surgery for odontogenic cyst intruding into maxillary sinus. Braz J Otorhinolaryngol. 2018;84(2):212-9.
  20. Ying Kai Hu, Chi Yang, Guang Zhou Xu, Qian Yang Xie. Digital design of functional surgery for odontogenic cyst intruding into maxillary sinus. Braz J Otorhinolaryngol. 2018 March-April; 84(2):212-9.
  21. Pragasm M, Managutti A. Diplopia with local anesthesia. Natl J Maxillofac Surg. 2011 Jan-Jun; 2(1):82-85.
  22. Bahşi İ, Orhan M, Kervancıoğlu P, Yalçın ED. Morphometric evaluation and clinical implications of the greater palatine foramen, greater palatine canal and pterygopalatine fossa on CBCT images and review of literature. Surg Radiol Anat. 2019 Jan; 41(5):551-567.
  23. Onurcem D, Varun K, Emel Tuğba A-D, Melek Didem T, Tolga Fikret T. Radio-Morphometric Evaluation of Greater Palatine Canal and Pterygopalatine Fossa Component: Maxillary Anesthetic Implications. J Craniofac Surg. 2019 May/June; 30(3):863-7.
  24. Kruchinskiy GV, Filippenko VI. Odontogennyy verkhnechelyustnoy sinusit [Odontogenic maxillary sinusitis]. M: Vysshaya shkola; 1991. 167 s. [Russian]
  25. Gayvoronskiy IV, Gayvoronskaya MG, Gudz AA, Semenova AA, Ponomarev AA. Topografo-anatomicheskie vzaimootnosheniya verkhnechelyustnykh pazukh s zubochelyustnymi segmentami verkhney chelyusti [Topographic-anatomical relationships of the maxillary sinuses with dental segments of the upper jaw]. Vestnik rossiyskoy voenno-meditsinskoy akademii. 2016;2(54):146-150. [Russian]
  26. Malinowski MN, Bremer NJ. Sphenopalatine Ganglion Block. Chapt 63. In: Deer's Treatment of Pain. Eds by Deer T, Pope J, Lamer T, Provenzano D. Switzerland: Springer Cham; 2019. p. 531-5.
  27. Sir E, Eksert S. Morphological Description and Clinical Implication of Sphenopalatine Foramen for Accurate Transnasal Sphenopalatine Ganglion Block: An Anatomical Study. Medeni Med J. 2019;34(3):239-243.
  28. Shedyakova NV, Petrikas A.ZH, Chestnyh EV. Analgesic preparation of the oral cavity to injection. Inst Stomat. 2017;4:76-7.
  29. Miller H Smith, Kevin E Lung. Nerve Injuries after Dental Injection: A Review of the Literature. J Can Dent Assoc. 2006;72(6):559-64.
  30. Wright GZ, Weinberger SJ, Marti R, Plotzke O. The effectiveness of infiltration anesthesia in the mandibular primary molar region. Pediatr Dent. 1991;13:278-83.
  31. Raouf Mohameda SA, Mohameda NN, Rashwanb D. Pulse co-oximetry perfusion index as a tool for acute postoperative pain assessment and its correlation to visual analogue pain score. Res Opin Anesth Intens Care. 2015 Jan;2(3):62-7.
  32. Takezawa K, Ghabriel M, Townsend G. The course and distribution of the buccal nerve: clinical relevance in dentistry. Austral Dent J. 2018 Mar; 63(1):66-71.
  33. Balasubramanian T. Local Anaesthesia of Nose and Nasal cavity- A Review. Glob J Oto. 2017;4(4):555643.
  34. Shamil E, Rouhani MJ, Basetti S, Bast F, Hopkins C, Surda P. Role of local anaesthetic nerve block in endoscopic sinus surgery: A systematic review and meta-analysis. Clin Otolaryngol. 2018 Oct;43(5):1201-1208.
  35. Piagkou M, Demesticha T, Troupis T, Vlasis K, Skandalakis P, et al. The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice. Pain Pract. 2012;12(5):399-412.
  36. Candido KD, Massey ST, Sauer R, Darabad RR, Knezevic NN. A Novel Revision to the Classical Transnasal Topical Sphenopalatine Ganglion Block for the Treatment of Headache and Facial Pain. Pain Physician. 2013 Nov/Dec; 16:E769-E778.
  37. Iwanaga J, Wilson Ch, Simonds E, Vetter M. Clinical Anatomy of Blockade of the Pterygopalatine Ganglion: Literature Review and Pictorial Tour Using Cadaveric Images. Kurume Med J. 2018 Jun;65(1):1-5.
  38. Cady R, Saper J, Dexter K, Manley HR. A double-blind, placebo-controlled study of repetitive transnasal sphenopalatine ganglion blockade with tx360® as acute treatment for chronic migraine. Headache. 2015;55(1):101-16.
  39. Shchuko AG, Yureva TN, Oleshchenko IG. Rol krylonyobnoy blokady v programme ranney reabilitatsii detey posle khirurgii vrozhdyonnoy katarakty [The role of the poultry blockade in the program of early rehabilitation of children after the surgery of congenital cataracts]. Oftalmologicheskie vedomosti. 2017;10(4):18-23. [Russian].
  40. Borodulnn VG. Nash opyt blokady verkhnechelyustnogo nerva i krylonebnogo uzla nebnym dostupom [Our experience of the blockade of the maxillary nerve and the cunning node with palatinal access]. Rossiyskaya Otorinolaringologiya. 2014;68(1):12-15. [Russian]