Retrograde Approach to Maxillary Nerve Block: An Alternative in Orofacial Surgeries in Horses.
Authors: Vuerich Matteo, Nannarone Sara
Journal: Animals : an open access journal from MDPI
Summary
# Editorial Summary: Retrograde Maxillary Nerve Block via the Infraorbital Canal Effective regional anesthesia for equine orofacial surgery has traditionally relied on approaches that risk inadvertent damage to periorbital structures; this retrospective analysis of 15 horses examined whether a retrograde technique through the infraorbital canal could provide a safer alternative with equivalent analgesic efficacy. Practitioners administered the maxillary nerve block using Tuohy needles (19–20 G for 350–600 kg horses, 21–22 G for younger animals and ponies) in horses undergoing either standing analgo-sedation (n = 6) for dental extractions, nasal polyp resection, and sinus disease, or general anesthesia (n = 9) for more extensive fronto-maxillary, nasal, and dental pathology. No complications occurred in either group, with all horses maintaining stable physiological parameters and adequate anesthetic depth throughout procedures. This work represents the first in vivo clinical application of a technique previously described only on cadaveric material, demonstrating that the retrograde infraorbital approach offers practitioners a reliable method for securing maxillary anesthesia whilst avoiding the periorbital complications—retrobulbar haemorrhage, globe trauma, and extraneous nerve involvement—associated with more traditional needle trajectories. The technique's simplicity and safety profile make it a valuable addition to the regional anesthesia toolkit for routine and complex orofacial procedures.
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Practical Takeaways
- •The retrograde infraorbital approach to maxillary nerve block is a safe, effective alternative technique for orofacial surgery in standing or anesthetized horses without the complications associated with traditional techniques
- •Proper needle gauge selection based on horse size and age (19-20G for adult horses 350-600 kg; 21-22G for younger horses/ponies) is important for successful block execution
- •This technique avoids damage to periorbital structures, making it a valuable option for maxillary nerve anesthesia in equine dental and sinus surgery
Key Findings
- •Retrograde maxillary nerve block via infraorbital canal was successfully applied in 15 horses (6 standing analgo-sedation, 9 general anesthesia) with no complications
- •Tuohy needles 19-20G were used in adult horses (350-600 kg) and 21-22G in younger horses/ponies
- •All horses maintained stable physiological parameters and adequate anesthetic/sedation depth throughout surgery with no periorbital structure damage or side effects