Abstract:We report a case of diplopia due to reversible abducens nerve block associated with extraoral maxillary blockade of the trigeminal nerve. This complication occurs despite precautions such as aspiration and confirmation of needle tip position with nerve stimulation. Knowledge of this condition and its potential cause should alert the physician to the importance of appropriate injection technique and an understanding of the management protocol.
“… 8 Second, the anesthetic agent accidentally flows into the pterygoid plexus and drains into the cavernous sinus, affecting the abducens nerve, which runs through the lateral wall of the sinus. 2 Lastly, direct diffusion of the anesthetic agent into the abducens nerve from the inferior to superior orbital fissure via the pterygopalatine fossa due to its proximity might cause diplopia ( Figure 3 ). 2 , 9 In our case, considering the contrast spread pattern in the fluoroscopic figure, diffusion was the most likely cause.…”
Section: Discussionmentioning
confidence: 99%
“… 2 Lastly, direct diffusion of the anesthetic agent into the abducens nerve from the inferior to superior orbital fissure via the pterygopalatine fossa due to its proximity might cause diplopia ( Figure 3 ). 2 , 9 In our case, considering the contrast spread pattern in the fluoroscopic figure, diffusion was the most likely cause. Figure 3 Schematic illustration of the pterygopalatine fossa.…”
Section: Discussionmentioning
confidence: 99%
“… 1 Chavali et al reported the case of a patient with trigeminal neuralgia, in whom alcohol neurolysis of the maxillary nerve through the lateral infrazygomatic approach caused diplopia. 2 A few other papers reported diplopia occurring during trigeminal radiofrequency thermocoagulation or alcohol neurolysis with the approach through the foramen ovale. 3–5 However, to the best of our knowledge, there have been no reports of diplopia after maxillary nerve block without neurolysis achieved through the lateral infrazygomatic approach.…”
Maxillary nerve block is widely used for treating trigeminal neuralgia. Common complications of the procedure include bleeding and sensory abnormalities, but ophthalmic complications have been rarely reported. A 60-year-old woman underwent maxillary nerve block for refractory trigeminal neuralgia. Ten minutes after the procedure had ended, the patient reported double vision when she tried to turn the left eye outward. After examination, the patient was presumed to have diplopia due to the abducens nerve block. However, the symptom disappeared approximately 30 minutes later without any treatment. Thus, to prevent diplopia, the dose of local anesthetics should be reduced. Moreover, negative blood aspiration should be confirmed during the injection. To the best of our knowledge, this is the first case to report diplopia after maxillary nerve block without neurolysis through the lateral infrazygomatic approach.
“… 8 Second, the anesthetic agent accidentally flows into the pterygoid plexus and drains into the cavernous sinus, affecting the abducens nerve, which runs through the lateral wall of the sinus. 2 Lastly, direct diffusion of the anesthetic agent into the abducens nerve from the inferior to superior orbital fissure via the pterygopalatine fossa due to its proximity might cause diplopia ( Figure 3 ). 2 , 9 In our case, considering the contrast spread pattern in the fluoroscopic figure, diffusion was the most likely cause.…”
Section: Discussionmentioning
confidence: 99%
“… 2 Lastly, direct diffusion of the anesthetic agent into the abducens nerve from the inferior to superior orbital fissure via the pterygopalatine fossa due to its proximity might cause diplopia ( Figure 3 ). 2 , 9 In our case, considering the contrast spread pattern in the fluoroscopic figure, diffusion was the most likely cause. Figure 3 Schematic illustration of the pterygopalatine fossa.…”
Section: Discussionmentioning
confidence: 99%
“… 1 Chavali et al reported the case of a patient with trigeminal neuralgia, in whom alcohol neurolysis of the maxillary nerve through the lateral infrazygomatic approach caused diplopia. 2 A few other papers reported diplopia occurring during trigeminal radiofrequency thermocoagulation or alcohol neurolysis with the approach through the foramen ovale. 3–5 However, to the best of our knowledge, there have been no reports of diplopia after maxillary nerve block without neurolysis achieved through the lateral infrazygomatic approach.…”
Maxillary nerve block is widely used for treating trigeminal neuralgia. Common complications of the procedure include bleeding and sensory abnormalities, but ophthalmic complications have been rarely reported. A 60-year-old woman underwent maxillary nerve block for refractory trigeminal neuralgia. Ten minutes after the procedure had ended, the patient reported double vision when she tried to turn the left eye outward. After examination, the patient was presumed to have diplopia due to the abducens nerve block. However, the symptom disappeared approximately 30 minutes later without any treatment. Thus, to prevent diplopia, the dose of local anesthetics should be reduced. Moreover, negative blood aspiration should be confirmed during the injection. To the best of our knowledge, this is the first case to report diplopia after maxillary nerve block without neurolysis through the lateral infrazygomatic approach.
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