14 - Selective Maxillary Nerve Block: Coronoid Approach

Abstract

Trigeminal nerve block through the coronoid approach is used to block the maxillary and mandibular divisions of the trigeminal nerve. The maxillary division (V2) of the trigeminal nerve is a pure sensory nerve. It exits the middle cranial fossa via the foramen rotundum and crosses the pterygopalatine fossa where it is amenable to blockade via trigeminal nerve block via the coronoid approach. The mandibular division (V3) is composed of a large sensory root and smaller motor root. Both leave the middle cranial fossa together via the foramen ovale and join to form the mandibular nerve. The smaller motor branch provides innervation to the masseter, external pterygoid, and temporalis muscles. The technique of trigeminal nerve block via the coronoid approach can be used to perform diagnostic, prognostic, and therapeutic neural blockade of the maxillary and mandibular divisions of the trigeminal nerve. This approach allows selective blockade of the maxillary and mandibular divisions, so the technique can also be applied in a prognostic manner before neurodestruction of these nerves. Procedures for neurodestruction of the maxillary and mandibular nerves by neurolytic agents, radiofrequency lesions, gamma knife, or freezing may be carried out using selective maxillary and mandibular nerve block techniques.