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Local Infiltration Anesthesia
Published in Marwali Harahap, Adel R. Abadir, Anesthesia and Analgesia in Dermatologic Surgery, 2019
Christie T. Ammirati, George J. Hruza
The innervation to the nose is similar to the ear in that circumferential infiltration of anesthesia blocks sensory input to all but its central portion. Branches of the infraorbital nerve supply the lateral nose and inferior nasal ala, and the infratrochlear nerve innervates the superior portion. The nasal tip and columella receive input from the external nasal branches of the anterior ethmoidal nerve, which exit at the junction of the nasal bone and lateral cartilages. The first step in this block is to infiltrate within the alar sulcus extending superiorly along the nasofacial crease (Fig. 6). The needle is then redirected inferomedially, and anesthesia is infiltrated along the nostril sill to the columella, extending over the anterior nasal spine. This procedure is subsequently repeated on the opposite side. Next, the needle is placed midline at the junction of the dorsum and root of the nose. Anesthetic is infiltrated laterally toward the medial canthus and then inferiorly within the nasofacial crease on both sides. This ring of anesthesia encircles the nose and anesthetizes the entire cutaneous surface except for the tip, which is supplied by the anterior ethmoidal nerve. This nerve emerges at the distal edge of the nasal bone where it joins the upper lateral cartilages. Once this junction has been palpated, the needle is inserted in the midline and anesthesia is infiltrated bilaterally in inferolateral directions toward both sides of the nose to complete the block.
Airway Management
Published in Elizabeth Combeer, The Final FRCA Short Answer Questions, 2019
Nasal air passages = ophthalmic and maxillary divisions of trigeminal nerve: Anterior septum and nares: anterior ethmoidal nerve (V1).Elsewhere: greater and lesser palatine nerves (V2).
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
These are the commonest facial fractures; the nose is a prominent feature and a frequent recipient of trauma due to either interpersonal violence or personal injuries such as falls, sports or RTA. The nasal bones usually fracture in their lower half where the bone is thinner. Experiments by Clark in 1970 showed that the nasal bones are more likely to break (i.e. less force required) from a lateral blow than a frontal blow. Numbness at the tip of the nose indicates anterior ethmoidal nerve injury. Diagnosis may be difficult if the patient presents whilst tissues are oedematous. It is important to rule out a nasoorbitoethmoid (NOE) fracture.
Lacrimal Gland Insufficiency in Aqueous Deficiency Dry Eye Disease: Recent Advances in Pathogenesis, Diagnosis, and Treatment
Published in Seminars in Ophthalmology, 2022
Acupuncture is a form of Chinese traditional medical therapy, wherein needles are applied at specific points on the body for neuronal stimulation. It has shown to be effective in treating DED. However, further studies are needed to gauge its efficacy.111–113 Role of anterior ethmoidal nerve stimulation being better than lacrimal nerve stimulation for increasing the aqueous production is also known.114 Intranasal Tear Neurostimulator (TrueTear, Allergan plc) is a similar device designed to deliver microcurrents to the nasal cavity, stimulating the nasolacrimal pathway. It has recently received FDA approval to temporarily increase tear production. It has shown significant improvements in ocular dryness and discomfort compared along with a good safety profile and hence appears to be a promising new management strategy for these patients.115 The iTEAR ®100 device is a similar device; however, unlike TrueTear, this stimulates the anterior ethmoidal nerves at the tip of the nose. Further clinical trials for its efficacy and safety are awaited.
Lipid nanoparticles for intranasal administration: application to nose-to-brain delivery
Published in Expert Opinion on Drug Delivery, 2018
Luigi Battaglia, Pier Paolo Panciani, Elisabetta Muntoni, Maria Teresa Capucchio, Elena Biasibetti, Pasquale De Bonis, Silvia Mioletti, Marco Fontanella, Shankar Swaminathan
Another important pathway for nose-to-brain delivery is the trigeminal nerve, which innervates the respiratory, but also the olfactory epithelium, and enters the CNS in the pons. The ophthalmic (ethmoidal nerves) and maxillary (nasal branches) divisions of the trigeminal nerve enter the brain from the respiratory epithelium through anterior lacerated foramen near the pons and through the cribriform plate near olfactory bulb. This unique feature creates entry points into both caudal and rostral brain areas. Because the entry through the cribriform plate is common to the olfactory and the trigeminal nerves, it is difficult to distinguish whether intranasally administered drugs reach the olfactory bulb and other rostral brain areas via the olfactory or trigeminal pathways or if both pathways are involved [8].
Challenges and developments in both surgical and non-surgical treatments for thyroid eye disease
Published in Expert Review of Ophthalmology, 2018
For the medial wall, the classic approaches were traditionally either a coronal access [40] or a Lynch incision midway between the medial canthus and nasal bridge. The coronal approach is a complex flap requiring repositioning of the supraorbital nerve and trochlea and may cause temporal wasting [41], frontal bossing, skin necrosis, alopecia, and forehead and scalp anesthesia [42]. The Lynch incision is associated with medial canthal scarring and may injure the trochlea, ethmoidal bundles, medial canthal tendon, and/or lacrimal sac. A recent development is the transcaruncular or retrocaruncular incision for access to the medial wall. These keyhole approaches reduce scarring, but the view may be challenging in very congested orbits in active disease (such as for DON). In such cases, the transcutaneous route remains a better option and avoids the risk of inducing inflammation and scarring of the medial rectus muscle insertion. Other possible complications after medial wall decompression are cerebrospinal fluid (CSF) leaks, and sinusitis and ethmoidal nerve anesthesia. To avoid those, the first step is to systematically examine the preoperative computed tomography to assess the cribriform plate height, and to rule out chronic sinusitis signs. If the decompression is nonurgent, rhinosinusitis treatment should precede surgery. Since incarcerated sinus mucosa or poorly aerated sinus cavities tend to lead to local inflammation and mucocele formation [43], it is wise to perform good fenestrations of the maxillary sinus and adequate anterior ethmoidectomy [44].