Greater Auricular Nerve Infiltration: An Effective Way To Control Per-Operative Pain During Mandibular Third Molar Surgery

Muhammad Afzal; Adnan  Babar; Babar  Pasha; Syed Gulzar Ali  Bukhari; Mubashir  Sharif; Azher Ali  Bangash

doi:10.51253/pafmj.v75i4.10164

Authors

Muhammad Afzal Department of Maxillofacial Surgery, 30 MDC, Combined Military Hospital Peshawar /National University of Medical Sciences (NUMS) Pakistan
Adnan Babar Department of Maxillofacial Surgery, 21 MDC, Combined Military Hospital Quetta /National University of Medical Sciences (NUMS) Pakistan
Babar Pasha Department of Maxillofacial Surgery, Rangers hospital, Lahore Pakistan
Syed Gulzar Ali Bukhari Department of Maxillofacial Surgery, Wateem Dental College, Rawalpindi Pakistan
Mubashir Sharif Department of Prosthodontist, Armed Forces Institute of Dentistry/ National University of Medical Sciences (NUMS) Pakistan
Azher Ali Bangash Department of Maxillofacial Surgery, 30 MDC, Combined Military Hospital Peshawar /National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i4.10164

Keywords:

Impactions, Nerve infiltration, Per-operative pain, Third molar

Abstract

Objective: To evaluate the efficacy of Greater Auricular Nerve infiltration (GANI) along with conventional Inferior Alveolar Nerve Block (IANB) in reducing pain during mandibular third molar surgery.

Study Design: Quasi-experimental study

Place and Duration of Study: Military Dental Centre Quetta, Pakistan from Jun 2020 to May 2021.

Methodology: One hundred patients recruited as per the inclusion criteria were divided in two groups. Group-A received inferior alveolar nerve block and greater auricular nerve infiltration, and Group-B received inferior alveolar nerve block only. Surgical removal of mandibular impacted third molar was carried out using same technique. Per operative pain score was recorded on visual analogue scale of 0-10. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 23. Chi square test was applied to compare presence/absence of pain while independent samples t test was used to compare mean pain scores between the study groups. The p value <0.05 was considered significant.

Results: Majority of the subjects (53%) had Class II impactions while 17% subjects had Class III impactions. Meantime taken for surgical procedure was 21.67±5.59 mins A higher percentage (70%) of subjects in Group-A reported an absence of pain during the surgical procedure in comparison to 12% subjects in Group-B (p<0.001)

Conclusion: Use of Greater Auricular Nerve anesthesia along with conventional IANB results in better per-operative pain control in mandibular third molar surgery.

Downloads

Download data is not yet available.

References

1. Sayed N, Bakarhir A, Pasha M, Al-Sudairy S. Complications of third molar extractions. Sultan Qaboos Univ Med J 2019; 19(3): e230-e235.https://doi.org/10.18295/squmj.2019.19.03.009

2. Lin K, Uzbelger FD, Barbe MF. Transverse cervical nerve: implications for dental anesthesia. Clin Anat 2013; 26(6): 688-692.

https://doi.org/10.1002/ca.22221

3. Lee CR, Yang HJ. Alternative techniques for failure of conventional inferior alveolar nerve block. J Dent Anesth Pain Med 2019; 19(3): 125-134.

https://doi.org/10.17245/jdapm.2019.19.3.125

4. Bitner D, Uzbelger FD, Axx K, Albandar AM. Description and evaluation of intra-oral cervical plexus anesthetic technique. Clin Anat 2015; 28(5): 608-613.https://doi.org/10.1002/ca.22543

5. Feuerstein D, Costa-Mendes L, Esclassan R, Marty M, Vaysse F, Noirrit E. The mandibular plane: a stable reference to localize the mandibular foramen, even during growth. Oral Radiol 2020; 36: 69-79.https://doi.org/10.1007/s11282-019-00381-6

6. Ella B, Langbour N, Caix P, Midy D, Deliac P, Burbaud P. Transverse cervical and great auricular nerve distribution in the mandibular area: A study in human cadavers. Clin Anat 2015; 28(1): 109-117.https://doi.org/10.1002/ca.22369

7. Sergeant ESG. Epitools - Epidemiological Calculators Australia: Ausvet; 2018 [cited 2024 1/10]. Available from: https://epitools.ausvet.com.au/.

8. Liaqat S, Ehsan A, Bukhari GA. Efficacy of greater auricular nerve infiltration anesthesia in patients having less than optimal analgesia after conventional inferior alveolar nerve block for surgical removal of mandibular third molar. Pak Oral Dent J 2011; 31(2): 252-254.

9. Crowley C, Drum M, Reader A, Nusstein J, Fowler S, Beck M. Anesthetic efficacy of supine and upright positions for the inferior alveolar nerve block: a prospective, randomized study. J Endod 2018; 44(2): 202-205.

https://doi.org/10.1016/j.joen.2017.09.014

10. Somuri AV, Rai AB, Pillai M. Extraction of permanent maxillary teeth by only buccal infiltration of articaine. J Maxillofac Oral Surg 2013; 12(2): 130-132.

https://doi.org/10.1007/s12663-012-0396-0

11. Yang F, Gao Y, Zhang L, Zheng B, Wang L, Sun H, et al. Local anaesthesia for surgical extraction of mandibular third molars: a systematic review and network meta-analysis. Clin Oral Investig 2020; 24(11): 3781-3800.

https://doi.org/10.1007/s00784-020-03490-3

12. Afkhami F, Pirmoazen S, Ardestani A, Fard MJK. Comparative evaluation of anesthetic efficacy of inferior alveolar nerve block and inferior alveolar nerve block plus buccal or lingual infiltration using articaine in mandibular molar with irreversible pulpitis: A preliminary prospective randomized single-blind clinical trial. . Quintessence Int 2021; 52(9): 820-826.

https://doi.org/10.3290/j.qi.b1864321

13. Jaroń A, Trybek G. The Pattern of Mandibular Third Molar Impaction and Assessment of Surgery Difficulty: A Retrospective Study of Radiographs in East Baltic Population. Int J Environ Res Public Health 2021; 18(11): 6016.

https://doi.org/10.3390/ijerph18116016

14. M Eshghpour M, Nezadi A, Moradi A, Shamsabadi4 RM, Rezaei NM, Nejat A. Pattern of mandibular third molar impaction: A cross-sectional study in northeast of Iran. Niger J Clin Pract 2014; 17(6): 673-677.

https://doi.org/10.4103/1119-3077.144376

15. Alsaegh MA, Abushweme DA, Ahmed KO, Ahmed SO. The pattern of mandibular third molar impaction and its relationship with the development of distal caries in adjacent second molars among Emiratis: a retrospective study. BMC Oral Health 2022; 22(1): 306. https://doi.org/10.1186/s12903-022-02338-4

16. Haddad Z, Khorasani M, Bakhshi M, Tofangchiha M, Shalli Z. Radiographic position of impacted mandibular third molars and their association with pathological conditions. Int J Dent 2021; 2021: 8841297.https://doi.org/10.1155/2021/8841297

17. Khan SU, Mehmood K, Rukhsar M, Khan I, Ibrahim A, Iqbal K, et al. Impacted mandibular third molars, a nuisance to neighboring mandibular molars: A radiographic study. Pak Armed Forces Med J 2023; 73(1): 115-117.

18. Mehmood K, Ahmed W, Khan N. Efficacy of greater auricular nerve block in eliminating pain during mandibular third molar extraction. Pak Oral Dent J 2015; 35(4): 574-577.

19. Rizqiawan A, Lesmaya YD, Rasyida AZ, Amir MS, Ono S, Kamadjaja DB. Postoperative Complications of Impacted Mandibular Third Molar Extraction Related to Patient's Age and Surgical Difficulty Level: A Cross-Sectional Retrospective Study. Int J Dent 2022;2022: 7239339.

https://doi.org/10.1155/2022/7239339

20. Suresh S, Barcelona SL, Young NM, Heffner L, Cote CJ. Does a preemptive block of great auricular nerve improve postoperative analgesia in children undergoing tympanomastoid surgery. Anesth Analg 2004; 98(2): 330-339.https://doi.org/10.1213/01.ane.0000097171.73374.ad