Trigeminal (gasserian) ganglion, maxillary nerve, and mandibular nerve blocks

Abstract

The Gasserian (trigeminal) ganglion lies within Meckel’s cavity in the middle cranial fossa close to the petrous bone. It is surrounded medially by the cavernous sinus, superiorly by the inferior surface of the temporal lobe, and posteriorly by the brain stem. Gasserian ganglion has three divisions with a characteristic somatotopic arrangement, in that the ophthalmic division (V1) is the most craniomedial and the mandibular division (V3) is the most caudolateral. The maxillary branch (V2) lies in between. The ophthalmic nerve exits through the superior orbital fissure, the maxillary nerve through the foramen rotundum, and the mandibular nerve through the foramen ovale. This chapter will cover the indications and techniques for trigeminal ganglion, maxillary nerve, and mandibular nerve blocks. Other trigeminal terminal branches blocks were discussed in a previous chapter.