Fig 5 - uploaded by Ahmed Z. Abdelkarim
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Illustration of the cutaneous, sensory nerves of the face. 1 = supraorbital nerve (1 a = medial branch, 1 b = lateral branch, 1 c = horizontal branch, 1 d = palpebral branches); 2 = supratrochlear nerve (2 a = forehead branches, 2 b = palpebral branch); 3 = infratrochlear nerve (3 a = nasal branches, 3 b = palpebral branch); 4 = palpebral branches of lacrimal nerve; 5 = external nasal branch of anterior ethmoidal nerve; 6 = infraorbital nerve (6 a = inferior palpebral branches, 6 b = external nasal branch, 6 c = internal nasal branch, 6 d = medial branch of superior labial branch, 6 e = lateral branch of superior labial branch); 7 = zygomaticofacial nerve (7 a = zygomatic branches, 7 b = palpebral branch); 8 = zygomaticotemporal nerve (8 a = temporal branches, 8 b = palpebral branch); 9 = auriculotemporal nerve (9 a = zygomatic branches, 9 b = auricular branches, 9 c = temporal branches); 10 = long buccal nerve; 11 = mental nerve (11 a = angular branch, 11 b = lateral labial branch, 11 c = medial labial branch, 11 d = mental branch); 12 = mental branch of mylohyoid nerve; 13 = great auricular nerve; 14 = transverse cervical nerve
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The face is a unique part of the body with its individual anatomical characteristics. While the dental clinician is usually focused on the oral cavity, the physical examination should involve close attention to the neurosensory status of the facial skin. Furthermore, skin sensitivity should be assessed pre-and postoperatively in conjunction with de...
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The face is a unique part of the body with its individual anatomical characteristics. While the dental clinician is usually focused on the oral cavity, the physical examination should involve close attention to the neurosensory status of the facial skin. Furthermore, skin sensitivity should be assessed pre- and postoperatively in conjunction with d...
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... Більшість операцій цистектомії одонтогенних кіст проводиться під місцевим потенційованим знеболенням. При цьому застосовуються стандартні методики провідникових анестезій, які поєднують із інфільтраційною анестезією [11][12][13][14][15]. Застосування стандартних методик мандибулярної та щічної анестезій не завжди є достатньо ефективними під час проведення операцій цистектомії у бічних ділянках нижніх щелеп [14], що пояснюється варіабельністю розгалуження трійчастого нерва [16][17][18], наявністю додаткової іннервації бічної ділянки нижньої щелепи гілками великого вушного та поперечного нервів шиї (від поверхневого шийного нервового сплетення) [19][20][21]. Для досягнення повного анестезіологічного ефекту пропонується додатково проводити інфільтраційну анестезію під оболонку кісти, або її порожнину перед енуклеацією виповнювати марлевим тампоном, змоченим 10% розчином лідокаїну з 0,1% епінефрином [14]. Ефективним є також застосування внутрішньокісткової анестезії в ділянці операційного втручання [22]. ...
The purpose of the study was to analyze the data of modern domestic and foreign professional literature, which are devoted to new surgical methods of treatment of odontogenic cysts, to highlight the results of own clinical studies on the effectiveness of developed methods of cystectomy in jaw bones and their anesthesia. Materials and methods. Analytical and bibliosemantic methods were used in the research. The search for scientific information on medical topics for the period from 2010 to 2021 was carried out in the databases of electronic searching systems. Results and discussion. The use of standard techniques of conduction anesthesia of the trigeminal nerve is not always effective during cystectomy in the lateral parts of the mandible, due to the variability of branching of the trigeminal nerve, the possibility of additional innervation of the jaw branch from the superficial cervical plexus. Taking into account these anatomical factors, it is painless to perform a cystectomy of odontogenic cysts on the mandible. During oronasal cystectomy of odontogenic cysts that have grown into the nasal cavity it is advisable to block the nasopalatine nerve in the middle nasal passage. Modified methods of marsupialization can be used as an independent method of treatment of odontogenic cysts of large size, or be combined with radical removal of the cyst membrane. The use of ultrasound medical techniques reduces the risk of damage to adjacent soft tissues during enucleation of bone membranes in complex topographic and anatomical areas. The use of modern laser technologies and medical radiophysical equipment can increase the effectiveness of surgical treatment of odontogenic jaw cysts. The use of endovideosurgery techniques reduces the percentage of intraoperative complications. The introduction of computer spatial imaging of anatomical objects in dental practice has made it possible to develop new surgical technologies for precision-guided osteotomy and resection of the tips of the roots of masticatory teeth adjacent to the shells of radicular jaw cysts. Conclusion. In modern clinical practice, technical developments are used, which are based on the latest advances in laser optics, radio physics, bioacoustics, computer technology, which minimizes injuries during cystectomy operations, reduces the frequency of intraoperative complications. Individual-anatomical features of innervation of the maxillofacial area should be taken into account during local anesthesia, cystectomy and cystotomy operations in the jaw bones
... Знание анатомии лица, особенно васкуляризации этой области, имеет важное значение для проведения эстетических и реконструктивных операций при формировании кожного лоскута, а в инъекционной косметологии анатомические ориентиры, которые специалисты могут определить при помощи ультразвукового сканирования, необходимы при введении препаратов [7]. Артерии, кровоснабжающие кожу лица, тесно связаны с его поверхностной мышечно-апоневротической системой. ...
... Лицевая артерия (a. facialis) является одной из восьми ветвей наружной сонной артерии, кровоснабжающих лицо, и выполняет важнейшую функцию, обеспечивая мышцы и кожу лица кислородом и питательными веществами [7]. Следует отметить, что у обследованных пациентов толщина всех слоев кожи была наименьшей в поднижнечелюстной зоне по сравнению с другими исследованными участками лица, наибольшейна подбородке (0,207 см). ...
... Лицевая артерия (a. Facialis) -одна из 8 ветвей наружной сонной артерии, которая снабжает кровью лицо и выполняет важную функцию, обеспечивая мышцы и кожу лица кислородом и питательными веществами[7]. С помощью цветного доплера можно определить местонахождение a. facialis и его ветви, чтобы оценить параметры кровотока в нем. ...
... It is well known that the sensory innervation of the maxillofacial area (MFA) is quite complicated. In the soft tissues of the face, the sensory branches of the trigeminal nerve as well as the cervical superficial nerve plexus are branching ( Figure 1) [1,2]. In adjacent anatomical sites, these nerves anastomose with each other. ...
n this article, the face and its functions will be briefly presented. This approach will be ap�proached from a mental, physical and social perspective. The aim of the article is to show in a ho�listic approach the difficulties faced by a person who “loses” his current face. Acquired changes
become the cause of disability understood in many aspects. Finally, selected acquired causes of de�formation of the orofacial complex are described in the form of: facial nerve palsy, trigeminal
nerve palsy and facial cancer.
Introduction:
The most common method of local anesthesia of maxillofacial region in the modern surgical practice is conductive anesthesia of the peripheral branches of trigeminal nerve. In order to reach the total anesthesia of the lateral facial region it is necessary to block not only auriculo-temporal and buccal nerves, but also facial branches of great auricular nerve taking part in the innervation of parotid-masticatory area and the part of the cheek. Topographic-anatomical investigations of corpses revealed the anatomical variability of the branching of great auricular nerve on the neck and the head. Taking into account the topographic-anatomical aspects of variability of innervation of the lateral facial region, we developed the method of conductive anesthesia of the facial branches of great auricular nerve.
The aim:
To evaluate the clinical effectiveness of the developed method of conductive anesthesia of the facial branches of great auricular nerve taking into account individual anatomical peculiarities of its branching in patients with the different forms of the skull.
Material and methods:
Clinical observations were conducted on 69 patients of different age (from 18 to 70) and sex (43 males and 26 females). Under the local anesthesia we conducted surgery in the parotid-masticatory region including: disclosure of the abscesses, excision of migrating granulomas or lymph nodes (in the cases of chronic hyperplastic lymphadenitis); excision of the benign tumors of the soft tissues (atheromas, lipomas, fibromas and keratoacanthomas), excision of the salivary fistulas and keloid scars. Depending on the used methods of local anesthesia of the soft tissues of the parotid-masticatory region the patients were divided into two clinical groups. The first group (30 patients) was exposed to conductive anesthesia of great auricular nerve by the method of P. Raj (2002). according to which the blockade of the nerve is conducted ahead the apex of mastoid process of the temporal bone. 39 patients after the signing of the written agreement were exposed to the developed method of conductive anesthesia of the facial branches of great auricular nerve. In order to detect the individual anatomical features of the facial part of the head in patients, the facial index was determined by the Garson`s formula. Pain sensitivity and perception in patients were studied using subjective and objective methods. The data were analysed by means of the Pearson’s chi–square tests.
Results:
It is revealed that total anesthesia of the soft tissues of the parotid-masticatory region in all cases was reached in patients with euriprosopic face shape (broad-faced) – in 8 patients of the first clinical group and 10 patients of the second. The least effective was the anesthesia of the anterior branch of great auricular nerve conducted according to P. Raj’s method (2002) in patients with leptoprosopic face shape. In patients with leptoprosopic face shape of the second clinical group after administering anesthesia according to the developed method in 9 cases total anesthesia was reached, in 2 cases pain sensitivity in the inferior-anterior quadrant remained (χ2 = 5,70; р < 0,05). Generally, in patients of the first clinical group the method of conducted anesthesia by P. Raj was effective in 19 cases (63,3 %), and the developed method of conductive anesthesia of the facial branches of great auricular nerve – in 36 cases (92,3 %) – χ2 = 8,85, р < 0,01.
Conclusions:
The results of the research confirm that the developed method of conductive anesthesia of the facial branches of great auricular nerve is more effective in comparison to methods of anesthesia commonly used in today dentistry surgical practice. It allows to reach the total anesthesia of the soft tissues of the parotid-masticatory region in 92,3 % patients with different face shapes.
The branching of the trigeminal nerve on the face has an individual anatomical variability. The individual variability of innervation of soft tissues of the maxillofacial area should be taken into account during their local anesthesia. During the blockade of the zygomaticofacial nerve in accordance with the well-known technique, only 74 % of the cases of anesthesia in the buccal and zygomatic areas were completely anesthetized. The aim of the study – to give a сlinical evaluation of the effectiveness of the developed method of anesthesia of the zygomaticofacial nerve. Materials and Methods. In the clinical observation 41 stationary stomatological patients with planned surgical interventions on the lateral facial area took part (in the buccal area – 16 patients, in the zygomatic area – 25 patients). In order to detect the individual anatomical features of the facial part of the head in patients, the facial index was determined by the Garson`s formula as the relation between the morphological height of the face and its width multiplied by 100. These patients were applied a developed method of conductive anesthesia of the zygomaticofacial nerve and compared its effectiveness with a known method. Pain sensitivity and perception in patients were studied using subjective and objective methods. Pain sensitivity was determined by injection of a needle (pinprick) into the epidermis. Pain perception during local anesthesia administration was evaluated by the Sounds, Eyes and Motor (SEM) scale. Results and Discussion. Taking into account the results of craniometric studies as well as the individual topographic and anatomical features of zygomaticofacial nerve branching in people with different types of skull structure, the technique of conduction anesthesia of the branches of the zygomaticofacial nerve was developed. During surgical treatment the effectiveness of the local anesthetic developed method was evaluated as good – it was observed in patients a stable anesthesia, without psychosomatic peculiarities as well as local and general complications. Conclusions. Application in clinical conditions of the technique of conductive anesthesia of the zygomaticofacial nerve, developed by us, in combination with the classical method of local anesthesia of the buccal nerve provides painless surgical interventions on the lateral area of the face. For the successful local anesthesia of the zygomatic and buccal regions, it is necessary to take into account the anatomical variability of the branch on the face of the zygomaticofacial nerve in patients with different types of skull structure and face shape.
