@article {Anugerah301, author = {Ariana Anugerah and Kim Nguyen and Antoun Nader}, title = {Technical considerations for approaches to the ultrasound-guided maxillary nerve block via the pterygopalatine fossa: a literature review}, volume = {45}, number = {4}, pages = {301--305}, year = {2020}, doi = {10.1136/rapm-2019-100569}, publisher = {BMJ Specialist Journals}, abstract = {Background and objectives Blockade of the trigeminal nerve and its branches is an effective diagnostic tool and potential treatment of facial pain. Ultrasound-guided injections in the pterygopalatine fossa (PPF) to block the trigeminal nerve divisions and sphenopalatine ganglion have been described but a consensus has yet to be reached over the ideal approach. We sought to delineate and compare the various approaches to the ultrasound-guided trigeminal divisions blockade via the PPF.Methods The literature search was performed by searching the National Library of Medicine{\textquoteright}s PubMed database, the Cochrane Database of Systematic Reviews and Google Scholar within the date range of January 2009{\textendash}March 2019 for keywords targeted toward {\textquotedblleft}trigeminal nerve,{\textquotedblright} {\textquotedblleft}maxillary nerve,{\textquotedblright} or {\textquotedblleft}pterygopalatine fossa,{\textquotedblright} {\textquotedblleft}ultrasound,{\textquotedblright} and {\textquotedblleft}nerve block,{\textquotedblright} using an English language restriction. Six papers were included in the final review: one prospective double-blinded randomized controlled trial, one prospective descriptive study, one case series, two case reports, and one cadaveric study.Results There are three main approaches to the ultrasound-guided trigeminal nerve branches blockade via the PPF: anterior infrazygomatic in-plane, posterior infrazygomatic in-plane, and suprazygomatic out-of-plane approaches. Each showed injectate spread to the PPF in cadaver, adult and pediatric patients, respectively.1{\textendash}5 Injectate used varied from 3 to 5 mL to 0.15 mL/kg.Conclusions These studies demonstrated that the PPF is a readily accessible target for the ultrasound-guided maxillary nerve block via three main approaches.2 The ideal approach is yet to be determined and must be further explored.}, issn = {1098-7339}, URL = {https://rapm.bmj.com/content/45/4/301}, eprint = {https://rapm.bmj.com/content/45/4/301.full.pdf}, journal = {Regional Anesthesia \& Pain Medicine} }