Bloqueio do nervo maxilar para redu??o de fraturas do osso zigomático e assoalho da órbita

摘要

BACKGROUND AND OBJECTIVES: There are few reports of zygomatic orbital floor or zygomatic arch fractures reduction under regional anesthesia. This study aimed at evaluating extraoral maxillary nerve block for zygoma and orbital floor fractures reduction. METHODS: Participated in this study 15 patients submitted to maxillary block according to Moore?s technique (lateral approach of the pterygoid plate) for reduction of isolated zygomatic arch fractures (8 patients) or orbit floor fractures associated to zygomatic arch fractures (7 patients). Patients were not premedicated. After sedation and local infiltration with 2 ml of 1.5% lidocaine and epinephrine 1:300,000 the maxillary nerve was blocked with 8 ml of the same anesthetic solution through a 10 cm 22G, short beveled needle. The following parameters were evaluated: blockade duration, onset, analgesia duration, failures, need for general anesthesia and complications. RESULTS: The first three blocks resulted in difficult punctures with two partial blocks and one failure. Remainder blocks were effective and patients have not referred any discomfort or pain during both blockade and surgery. Blockade time varied from 5 to 20 minutes while onset varied from 3 to 10 minutes. There were 7 vascular punctures (7 patients) however without hematomas. CONCLUSIONS: Zygomatic fractures reduction is feasible under maxillary nerve block when performed in pterygopalatine fossa inducing anesthesia in its two distal branches: zygomaticotemporal and zygomaticofacial nerves