During blockade (G. Brown, J. Bercher, V.M. Uvarov, J.S. Weisblat, V.A. Dubov, P.Yu. Stolyarenko) and surgical interventions in the area of the infratemporal fossa, difficulties in finding the mandibular nerve and its motor branches arise, the possibility of injury to the maxillary and middle meningeal artery emerges, while the applied spatial-layered description of the anatomical structures from the mandibular notch to the formations on the base of the skull (foramen ovale, spinous process and foramen of the same name) is absent. Aim. To carry out a spatial-layer-by-layer preparation with a description of the anatomical structures of the infratemporal fossa to ensure and develop a safe path for blockades of the mandibular nerve and its motor branches. Anatomical structure of the infratemporal fossa must be taken into account when blocking the mandibular nerve at the foramen ovale. Based on the analysis of the technology employed and on the results of 62 blockades of the mandibular nerve adjacent to the foramen ovale, data on the features of the topographic and anatomical structure of the temporal fossa which should be considered is presented.When advancing the needle in the infratemporal fossa, consider the following anatomical structures. Above shifting to the facial artery into the depth of the deep lobe of the parotid gland, the external carotid artery at the level of the articular process is divided into two branches: the superficial temporal artery and the maxillary. In order to systematize the branches of the artery in topographic anatomy, this is divided into three parts: mandibular, pterygoid and pterygo-palatine. In the mandibular part of the artery, the deep auricular and anterior tympanic artery departing from it are directed posteriorly, upward to the ear and the tympanic cavity, and in the projection of the mandibular notch the middle meningeal artery (a.meningea media) and the lower alveolar artery (a.alveolaris inferior) are present. Moreover, in the area of the mandibular notch a.maxillaris is presented in the form of a loop lowered downward and a.alveolaris inferior. This arcuate bend of the maxillary artery is designed for elasticity, relieving tension in the arteries when opening the mouth (high and complex range of mandible motion). For the same purpose, nature provides for loops of the lingual and mandibular nerves. The reasons for failures and complications are shown and discussed. The ways of preventing complications in these types of blockades are indicated.
Keywords:- blockade
- foramen ovale
- infratemporal fossa
- mandibular nerve