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Background and Aims:Ultrasound (USG)-guided injection in pterygopalatine fossa is an indirect approach to block the trigeminal nerve. Trigeminal nerve block for maxillofacial surgeries may provide preemptive analgesia, reduce opioid consumption and opioid-related adverse effects.Methods:In this randomised, prospective double-blind study, 60 American Society of Anesthesiologists I/II patients, within the age group of 18–60 years scheduled for faciomaxillary surgery (fracture/pathological lesion of maxilla or mandible and cleft lip), were recruited. The patients were allocated in either of the two groups: group I: general anaesthesia (FENT group) and group II: general anaesthesia + trigeminal nerve (TNB group). Perioperative opioid consumption and postoperative pain scores were recorded. Any adverse effects like respiratory depression and nausea were also looked for.Results:Patients in group II required less intraoperative fentanyl top ups (1.17 ± 0.53 vs 2.70 ± 0.53) (P < 0.05). Postoperative opioid consumption was also less in this group (0.93 ± 0.69 vs 3.53 ± 0.68) (P < 0.05).Conclusion:USG-guided TNB reduces perioperative opioid consumption in patients undergoing faciomaxillary surgery with better patient pain scores.

Introduction:Low-flow vascular malformations (LFVMs) of the tongue are one of the most common presentations among different vascular anomalies of oral and maxillofacial regions. The present study was conducted with the objective to assess the outcome of a simple, easily available, safe and cost-effective therapeutic measure using foamed polidocanol in patients with LFVMs of the tongue.Materials and Methods:Fifteen patients with LFVMs of tongue were randomly selected in the study from the pool of 32 individuals affected with vascular malformation of oral and maxillofacial region. The diagnosis was made by a combination of clinical presentation and Doppler ultrasound. Lesions on the tongue were measured along their longer axis using a calliper and assigned to one of the three groups according to size: small-sized (<1 cm; 3 patients), medium-sized (between 1 and 3 cm; Four patients), or large-sized (>3 cm; eight patients). Foam sclerotherapy was done by directly injecting the foam (polidocanol) into identified sinusoids, under real-time ultrasound guidance. Foam polidocanol was prepared using the Tessari method.Results:Fifteen patients (Nine males and Six females), aged 7–50 years, with an average age of 23.53 years were included in our study. Of these 15 vascular lesions, three were small (<1 cm), four were medium (1–3 cm) and eight were large (>3 cm) in size. Treatment results were evaluated based on a reduction in lesion size. Complete or partial regression of lesions was reported by 14 (93.33%) patients and remained unchanged in one (6.67%) patient. The number of sclerotherapy sessions performed in this study ranged from 1 to 6 and was directly related to lesion size. Small- and medium-sized lesions responded well and complete resolution was seen in 1–3 sessions. Of the eight large lesions, seven showed complete or partial resolution in 4–6 sessions except one lesion which did not show any responses in subsequent sessions.Conclusion:Foam polidocanol therapy for LFVM of tongue is cost-effective, less invasive and with added advantage of local anesthetic effect.