Landmark of Ultrasound-Guided Trigeminal Block: Lateral Pterygoid Muscle.

I read with great interest the recent article by Antoun Nader and colleagues (1) and a similar technique present in another article (2). From an anatomical point, insertion into the lateral pterygoid muscle is on the lateral pterygoid plate and the origin is the mandible. From the computed tomography image (3), we can understand that the lateral pterygoid muscle can be detected by ultrasound between the condylar process and coronoid process of the mandible. So here we offer a corresponding image for the technique of ultrasoundguided trigeminal nerve block. In the ultrasound picture, we can identify the coronoid/condylar process of the mandible clearly as in the computed tomography scan. In between these 2 bony landmarks, there is a pulsating maxillary artery, which can be detected clearly on color Doppler. Beneath this artery is the lateral pterygoid muscle. While performing the ultrasound-guided injection, the needle was advanced from lateral to medial and from posterior to anterior, just passing through the lateral pterygoid muscle while being careful not to damage the maxillary artery. We successfully used this alternative approach to treat trigeminal neuralgia by ultrasound guidance in an office setting.