• Alexander P Marston, Glenn Merritt, Jonathan M Morris, and Shelagh A Cofer.
• Department of Otorhinolaryngology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA. Electronic address: marston.alex@gmail.com.
• Int. J. Pediatr. Otorhinolaryngol. 2018 Feb 1; 105: 85-89.

ObjectivesThe suprazygomatic maxillary nerve block is associated with improved post-operative pain management after select craniofacial surgical procedures. This study's objective is to better define the impact of pediatric facial skeletal growth on techniques for accessing the pterygopalatine fossa (PPF).MethodsPediatric patients with prior thin-slice maxillofacial computed tomography imaging were identified in an institutional radiology database. Aquarius image-processing software (Ver. 4.4.11, TeraRecon, Inc., Foster City, CA) was used to measure from the suprazygomatic skin to the greater wing of the sphenoid where the needle is then re-oriented in an anterior and inferior trajectory allowing it to advance into the PPF.ResultsA total of 90 patients ranging from 0 to ≤18 years of age were included in the study. The mean distance from the suprazygomatic skin to the foramen rotundum in patients 0 to ≤12 months of age and >13 to ≤18 years of age was 38.6 (SD ± 4.7) and 47.1 (SD ± 3.2) mm, respectively (p < .0001). The statistical analysis demonstrated a positive correlation between age in years and all of the measured distances (p = .0001). With respect to the plane of the needle entry site, the anterior and inferior angles required for passage into the PPF in the 0 to ≤12 months age group were 11 (SD ± 2.1) and 9.0 (SD ± 2.5) degrees, respectively, compared to those in the >13 to ≤18 years of age group at 12.4 (SD ± 1.9) and 12.1 (SD ± 3.2) degrees, respectively. These data reveal that patients in the oldest compared to the youngest pediatric age groups require significantly greater needle insertion, yet the angles of needle re-orientation are clinically similar between these two pediatric age groups varying by up to only 3°.ConclusionAs expected, the distance from the skin to the foramen rotundum increases significantly with age; however, the angles of re-orientation with respect to the original needle entry site demonstrated up to only 3° of variability between the youngest and oldest age groups evaluated in this pediatric cohort.Copyright © 2017 Elsevier B.V. All rights reserved.

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