Serratus Posterior Superior Intercostal Plane Block: A Technical Report on the Description of a Novel Periparavertebral Block for Thoracic Pain.

Background and objective We report a novel block technique aimed to provide thoracic analgesia: the serratus posterior superior intercostal plane (SPSIP) block. Design A cadaveric evaluation along with a retrospective case series evaluating the potential analgesic effect of the SPSIP block. This study included one unembalmed cadaver and five patients. Interventions Bilateral ultrasound-guided SPSIP block was used on cadavers with 30 mL of methylene blue 0.5% on each side; single-injection SPSIP blocks were used in patients. To measure results, dye spread was used in the cadaver, and dermatomal/pain score evaluation was used in patients. Main results Anatomical investigation in one unembalmed cadaver shows that its mechanism of action covers the rhomboid major muscle, erector spinae muscle, the deep fascia of the subscapularis/serratus anterior muscles, and intercostal nerves. In our patients, SPSIP resulted in an almost complete sensory block in the back of the neck, shoulder, and hemithorax. Conclusion Our cadaveric study shows extensive dye spread from C7 to T7. Patients who were administrated SPSIP block reported consistent dermatomal blockade from C3 to T10 levels of the hemitorax. The SPSIP block seems to be a safe, simple, and effective technique for thoracic analgesia.

Evaluation of genial tubercle anatomy using cone beam computed tomography.

The purpose of this study was to characterize the anatomy of the genial tubercle using cone beam computed tomography (CBCT). The morphology and detailed anatomy of the genial tubercle were assessed retrospectively in 201 patients (101 females, 100 males) using CBCT images. The parameters examined were the height (GH) and width (GW) of the genial tubercle, the distance from the lower incisors to the superior border of the tubercle (I-SGT), the distance from the inferior margin of the tubercle to the inferior margin of the mandible (IGM-IBM), and the anterior mandible thickness (AMT). Statistical analysis was performed to assess relationships among these parameters, gender, and orthodontic malocclusion (P < 0.05). The values obtained were GH 7.3-8.7 mm, GW 7.9-9.2 mm, I-SGT 7.1-9.1 mm, IGM-IBM 8.3-10.1 mm, and AMT 14.0-16.2 mm. GH, GW, and I-SGT showed no significant differences between genders (P > 0.05). However, IGM-IBM was larger for class III than for class I and class II male patients, and larger than for class I female patients. AMT in class III patients was greater than in class I and II patients (P < 0.05). The use of CBCT, which employs less radiation, is important for dental professionals, especially those performing surgery for obstructive sleep apnea (OSA), in order to avoid possible surgical complications.

Evaluation of the pterygoid hamulus morphology using cone beam computed tomography.

OBJECTIVE: This study consists of anatomic research of the pterygoid hamulus (PH) using 3D cone beam computed tomography (CBCT) images reconstructed from a volumetric rendering program. STUDY DESIGN: Three hundred ninety-six sides in the CBCT scans of 198 (115 men and 83 women) patients were retrospectively analyzed. DICOM data of the patients were transferred to a surface-rendering software so as to generate 3D hard tissue surface representations of PHs. The width, length, angle, and the distance between posterior nasal spine and tip of the PH were measured. In addition, the inclinations of PHs were also evaluated in sagittal and coronal planes of the 3D images. Pearson χ(2) and Student t test were performed for statistical analysis among age, localization, and measurements (P < .05). RESULTS: The mean PH measurements of left and right sides were 1.72 (SD 0.94) and 1.87 (SD 1.17)-mm width, and the lengths were 5.48 (AD 1.94), and 5.40 (SD 2.0) mm, respectively, with no significant difference (P > .05). All PHs were inclined toward the lateral side in the coronal plane, whereas PHs tended to incline toward the posterior rather than anterior in the sagittal plane (∼78%). The results showed no statistically significant differences among age, localization, and measurements of PHs (P > .05). CONCLUSIONS: Knowledge about the morphology of these structures is helpful for the interpretation of imaging and provides valuable information in the differential diagnosis of untraceable pains in the oral cavity and pharynx. Because of potential problems owing to PH morphology and elongation, oral and maxillofacial radiologists should assess the radiographic images thoroughly.