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This article describes a technique for the delivery of local anesthetic to the masseteric nerve just before it innervates the masseter muscle. As the mandibular division (V3) of the trigeminal nerve exits foramen ovale, the anterior division of V3 along with the masseteric nerve travels in the infratemporal fossa. Eventually, the masseteric nerve passes through the mandibular notch to innervate the masseter muscle. With the aid of a cadaveric dissection, an infiltration technique for the regional blockade of the masseter muscle was devised. The masseteric nerve block is an effective technique for obtaining anesthesia in the whole masseter muscle. This peripheral nerve block provides another modality for the treatment of acute and chronic masseter muscle pain. The masseteric nerve block can also be used diagnostically to verify the source of pain. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to document sensory changes in the supraorbital, infraorbital, and mental nerve distributions following acute and chronic maxillary and frontal sinusitis. METHOD AND MATERIALS: Seven patients with a total of 14 infected sinuses were included in the study. Neurosensory function was evaluated by measuring the electrical detection threshold for large myelinated nerve fibers and heat detection thresholds for the assessment of the thin unmyelinated nerve fibers. The sensory tests were conducted in the infraorbital, supraorbital, and mental dermatomes. Patient evaluation included clinical examination and computerized tomographic imaging of the sinuses. Sinusitis symptoms of 1 month or less were considered acute, and symptoms that persisted for more than 3 months were considered chronic. Detection thresholds in 8 healthy volunteers served as controls. RESULTS: Eight acute and 6 chronic sinusitis cases were diagnosed. Acute sinusitis produced bilateral large myelinated fiber hypersensitivity (electrical) relative to healthy controls, with no significant change in the thin unmyelinated nerve fiber detection threshold (thermal). Chronic sinusitis resulted in large myelinated fiber hyposensitivity and thin myelinated fiber bilateral hyposensitivity, as compared to healthy controls. CONCLUSIONS: This study concurs with previous studies in finding that early inflammatory neuritis can produce large myelinated nerve fiber hypersensitivity, while long-lasting processes, presumably accompanied with early nerve damage, may result in hyposensitivity. [ABSTRACT FROM AUTHOR]

A 50-year-old white woman was referred to the emergency room of the University of Medicine and Dentistry of New Jersey with a major complaint of right facial pain of 3 months' duration. A comprehensive intraoral and extraoral examination was performed. She reported a limited mandibular opening and the need for a soft diet for approximately 1 month. Her medical history was noncontributory. The examiner, suspecting a lesion because of the lack of response to masseteric injection and the pateint's ongoing report of facial numbness, referred the patient for imaging. A CT scan and MRI revealed a large mass in the right nasopharyngeal submucosa that extended into the nasopharyngeal space. The magnitude of the finding was not anticipated. This case demonstrates several important aspects relative to dental care: Orofacial pain is complex; evaluation of the history of a patient with orofacial pain is quite different from evaluating a patient with dental pain; and more training is required to treat patients with unusual oral and facial pain complaints. (Quintessence Int 2010;41:387-389). [ABSTRACT FROM AUTHOR]