Ear, nose & throat: Overview

The Journal of Head and Neck Anesthesia (JoHNA) is the official open access journal of the Society for Head and Neck Anesthesia (SHANA, www.shanahq.com). The field of head and neck (H&N) anesthesia is changing and developing rapidly. JoHNA was founded with an aim to serve as a top, up-to-date information resource for research and latest clinical advances in perioperative care for patients requiring H&N surgery.

The Journal scope includes perioperative optimization and anaesthetic management, patient outcomes, airway management, equipment, and training as they relate to head and neck anesthesia. JoHNA publishes original research articles, reviews, editorials, case reports and letters to the editor.

Introduction: Nerve block technology is widely used in clinical practice for pain management. Conventional nerve localization methods, which only rely on palpation to identify anatomical landmarks, require experienced surgeons and can be risky. Visualization technologies like ultrasound guidance can help prevent complications by helping surgeons locate anatomical structures in the surgical area and by guiding the operation using different kinds of images. There are several important and complex anatomical structures in the oral and maxillofacial regions. The current article reviews the application of ultrasound guidance in oral and maxillofacial nerve blocks.

Methods: We searched the literature on the use of ultrasound guidance for the main nerve block techniques in the oral and maxillofacial regions using both PubMed and MEDLINE and summarized the findings.

Results and discussion: A review of the literature showed that ultrasound guidance improves the safety and effectiveness of several kinds of puncture procedures, including nerve blocks. There are two approaches to blocking the mandibular nerve: intraoral and extraoral. This review found that the role of ultrasound guidance is more important in the extraoral approach. There are also two approaches to the blocking of the maxillary nerve and the trigeminal ganglion under ultrasound guidance: the superazygomatic approach and the infrazygomatic approach. The infrazygomatic approach can be further divided into the anterior approach and the posterior approach. It is generally believed that the anterior approach is safer and more effective. This review found that the effectiveness and safety of most oral and maxillofacial nerve block operations can be improved through the use of ultrasound guidance.

Head and neck surgery encompass a wide range of procedures from common tonsillectomy to major head and neck cancer
resections requiring free flap reconstruction. Anesthetic management of these procedures relies predominately on general anesthesia; however, regional anesthetic techniques are available that can be used for both the primary anesthetic and analgesia, or in
combination with general anesthesia. Traditionally most of these blocks were done blindly using anatomical structures, but with
more availability of ultrasounds, these blocks are easier to perform, and with less complications. In this review, we will discuss the
anatomical and ultrasound-guided approaches to regional anesthetic techniques that can be used in head and neck surgeries for
primary intraoperative management, or in combination with general anesthesia for perioperative pain management. A discussion of
outcomes studies of the different nerve blocks and potential complications associated with block placement will be highlighted.