Оптимізація місцевого знеболювання м’яких тканин бокової ділянки обличчя шляхом застосування розроблених методик анестезій лицевих гілок поверхневого шийного нервового сплетення
Authors: Mokryk O. Ya. 
Published: October 2017

The lateral facial region including zygomatic, parotid and buccal regions is innervated by trigeminal nerve branches: zygomatic, auriculotemporal, buccal, mental nerves as well as by branches of cervical plexus: great auricular and transverse cervical nerves. According to the classical Brown’s method, great auricular and transverse cervical nerves can be blocked at Erb’s point on the posterior border of the sternocleidomastoid muscle.Anesthesia of the listed nerves is commonly attained in the contemporary surgical practice during superfi cial cervical plexus block. However, due to the high probability of local complications such as external jugular veindamaging by the injection needle this technique can’t be used in the outpatient surgical dental practice.The aim of the study – to develop methods of conduction anesthesia of facial branches of cervical plexus (great auricular and transverse cervical nerves) on patient’s face considering individual topographic anatomical peculiarities.Materias and Methods. Clinical observation was conducted in 39 sheduled patients of different sex and age (18–60 years old) that were being on stationary treatment. In case the localization of pathological processes (benign tumors, keloid scars, fi stulas of migrating granulomas) in the parotid region (21 cases) surgical interventions were conducted under local conduction anesthesia of auriculotemporal nerve as well as facial branches of great auricular and transverse cervical nerves. In case the localization of pathological processes in the buccal region (18 cases) surgical interventions were conducted under local conduction anesthesia of buccal, mental nerves and facial branches of transverse cervical nerve (if necessary). Facial branches of great auricular nerve were blocked along the posterior border of mandible ramus – from the gonial angle to the neck of mandibular condyle. Anesthesia of facial branches of transverse cervical nerve was conducted along the inferior border of mandible. Individual topographic anatomical peculiarities of the facial part of the head in patients were determined by computing the facial index of each patient using Garson’s algorithm. Tactile and pain sensitivity were explored. In order to assess objectively the developed method of great auricular nerve block it was used stimulating electromyography. It is established that pathological processes did not infl uence the sensory function (tactile and pain sensitivity) of the zygomatic, parotid and buccal regions in patients before the planned surgical interventions on the lateral facial region.Results and Discussion. After the block of facial branches of great auricular nerve according to the developed technique it is revealed that in all cases the posterior part of the parotid region adjoining the mandible angleand posterior part of mandible ramus became insensitive. In 19 cases (93.1 %) an absolute anesthesia of this topographic anatomical region occurred. In 7 cases (33.4 %) the conduction anesthesia of facial branches oftransverse cervical nerve was carried out when this nerve took part in the innervation of the parotid region. It is clinically confi rmed that there are three types of ramifying on the human face of branches of great auricular and transverse cervical nerves (Bruno Ella classifi cation, 2015). The fi rst type of the lateral facial region innervation by the rami of cervical plexus occurred the most frequently, in 11 cases (52.4 %), and prevailed in patients with mesoprosopic form of facial part of the head. The second type of ramifying was observed in 7 cases (33.4 %), in patients with euriprosopic and mesoprosopic face shapes. The third type occurred in 14. 3 % cases in patients with mesoprosopic and leptoprosopic face shapes. In those people a major part of the lateral facial region was innervated by auriculotemporal nerve. In 55. 6 % cases a scattered type of buccal nerve ramifying was found on the face in patients prevailing in leptoprosops. In three patients transverse cervical nerve took part in the buccal region innervation. In all cases they were individuals with euriprosopic face shape. The loss of tactile and pain sensitivity on the skin cover of both the parotid and buccal regions as well as temporary absence of conductance along the facial branches of great auricular nerve that was detected during stimulating electromyography absolutely confi rmed the effectiveness of the developed methods of local conduction anesthesia. During surgical treatment the effi ciency of used methods of local anesthesia was evaluated on 4.7 ± 0.5 points – it was observed a stable anesthesia, without psychosomatic peculiarities as well as local and general complications, in patients; sometimes weakly expressed affective reactions took place, but they didn’t infl uence the course of the operation.Conclusions. The results of clinical observations confi rm the signifi cant variability of sensitive innervation of soft tissues of the lateral facial area, it varies in patients depending on their individual anatomical features.There are three types of branching in the parietal-chewing area of the facial branches of the surface cervical nerve plexus, which can spread to the cheek area. The use of techniques, conductive anesthetics of the facial branches of the large anus and transverse nerve of the neck, in combination with the traditional methods of local anesthesia, which we developed, provided painless surgical interventions on the lateral face of the face.