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Background <p>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.</p> Case presentations <p>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&#xa0;mL of 0.25% levobupivacaine. All patients demonstrated excellent postoperative pain control (numerical rating scale score ≤ 2) with minimal analgesic requirements and no complications.</p> Conclusion <p>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.</p>

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Ultrasound-guided lateral pterygoid muscle injection for inferior alveolar nerve block in sagittal split ramus osteotomy: a three-case series

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月16日

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  • Keisuke Nakazawa,
  • Ryota Tsukui,
  • Yoshio Ohyama,
  • Yoshinori Inaba,
  • Junko Tamari,
  • Takahiro Suzuki

摘要

Background

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.

Case presentations

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.

Conclusion

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.