{"id":4009,"date":"2017-01-11T15:18:00","date_gmt":"2017-01-11T15:18:00","guid":{"rendered":"https:\/\/taysirassistance.tn\/fr\/?p=4009"},"modified":"2017-01-11T15:18:00","modified_gmt":"2017-01-11T15:18:00","slug":"complication-du-blocs-de-la-face","status":"publish","type":"post","link":"https:\/\/taysirassistance.tn\/fr\/complication-du-blocs-de-la-face\/","title":{"rendered":"Complication du blocs de la face"},"content":{"rendered":"

Complications<\/strong><\/p>\n

L\u00e9sions et br\u00e8ches vasculaires. Accidents\u00a0<\/strong>toxiques<\/strong><\/p>\n

Tous les nerfs sont accompagn\u00e9s d\u2019un p\u00e9dicule art\u00e9riel (nerfs\u00a0<\/strong>supra- et infraorbitaire) ou proches d\u2019un axe art\u00e9riel important\u00a0<\/strong>(nerf mandibulaire et art\u00e8re maxillaire). Seul le nerf maxillaire\u00a0<\/strong>au trou rond est au-dessus des vaisseaux. Une approche par\u00a0<\/strong>neurostimulation va r\u00e9duire fortement le risque de plaie\u00a0<\/strong>art\u00e9rielle. Pour r\u00e9duire le risque toxique par injection intravasculaire\u00a0<\/strong>(mais aussi par r\u00e9sorption), il est n\u00e9cessaire d\u2019associer\u00a0<\/strong>une injection la plus lente possible, l\u2019utilisation de petits\u00a0<\/strong>volumes d\u2019anesth\u00e9sique local et l\u2019adjonction d\u2019un adjuvant de\u00a0<\/strong>type clonidine. Des manifestations toxiques retard\u00e9es sont\u00a0<\/strong>possibles, imposant une vigilance prolong\u00e9e apr\u00e8s la r\u00e9alisation\u00a0<\/strong>des blocs.<\/strong><\/p>\n

Accidents neurologiques<\/strong><\/p>\n

Les seuls accidents notoires sont l\u2019extension de l\u2019anesth\u00e9sie\u00a0<\/strong>aux nerfs moteurs. Ainsi, on peut parfois obtenir une paralysie\u00a0<\/strong>faciale (par diffusion au nerf facial) ou une ptose palp\u00e9brale.<\/strong><\/p>\n

Tous ces incidents sont r\u00e9gressifs spontan\u00e9ment. L\u2019accident\u00a0<\/strong>majeur demeure le traumatisme direct du nerf aux foramens, se\u00a0<\/strong>traduisant par des paresth\u00e9sies r\u00e9siduelles et de ce fait l\u2019injection\u00a0<\/strong>intracanalaire est \u00e0 rejeter formellement.<\/strong><\/p>\n

Accidents articulaires<\/strong><\/p>\n

L\u2019injection intramusculaire dans les muscles pt\u00e9rygo\u00efdiens\u00a0<\/strong>peut entra\u00eener un blocage de l\u2019articulation temporomandibulaire,\u00a0<\/strong>avec une ouverture buccale limit\u00e9e et un\u00a0<\/strong>trismus [33].<\/strong><\/p>\n

Conclusion<\/strong><\/p>\n

L\u2019anesth\u00e9sie locor\u00e9gionale de la face est accessible au\u00a0<\/strong>moyen de deux types de blocs : des blocs profonds (nerf\u00a0<\/strong>maxillaire et nerf mandibulaire), innervant un territoire large\u00a0<\/strong>et de r\u00e9alisation sp\u00e9cialis\u00e9e, et des blocs superficiels d\u2019acc\u00e8s\u00a0<\/strong>tr\u00e8s facile et simples \u00e0 r\u00e9aliser, mais couvrant des territoires\u00a0<\/strong>plus r\u00e9duits, bien que des associations de plusieurs blocs\u00a0<\/strong>puissent \u00eatre r\u00e9alis\u00e9es. Pour pouvoir aborder ces techniques,\u00a0<\/strong>il faut acqu\u00e9rir des connaissances anatomiques. L\u2019utilisation\u00a0<\/strong>de petits volumes permet de limiter le risque de toxicit\u00e9\u00a0<\/strong>syst\u00e9mique. Pour pouvoir offrir au patient le meilleur rapport\u00a0<\/strong>b\u00e9n\u00e9fice-risque, il faut associer une bonne technicit\u00e9, une\u00a0<\/strong>indication bien pos\u00e9e (avec implication du chirurgien) et le\u00a0<\/strong>strict respect des proc\u00e9dures de r\u00e9alisation de ces blocs de la\u00a0<\/strong>face.<\/strong><\/p>\n

R\u00e9f\u00e9rences<\/span><\/strong><\/p>\n

[1]<\/span> Gray\u2019s Anatomy. The anatomical basis of clinical practice<\/span><\/em>. Edinburgh:\u00a0<\/span><\/strong>Elsevier; 2005 (p. 512-4, 519-25, 578-9, 698-700).<\/span><\/strong><\/p>\n

[2] Moore KL, DallayAE.<\/span> Anatomie m\u00e9dicale<\/em>. Paris, Bruxelles: De Boeck\u00a0<\/strong>universit\u00e9; 2001 (p. 857-61, 922-3, 951).<\/span><\/strong><\/p>\n

[3] Katz J. In:<\/span> Atlas of regional anesthesia<\/span><\/em>. East Norwalk: Appleton and\u00a0<\/span><\/strong>Lange; 1994. p. 8-9.<\/span><\/strong><\/p>\n

[4] KnizeDM.Astudy of the supraorbital nerve.<\/span> Plast Reconstr Surg<\/em> 1995;\u00a0<\/strong>96:564-9.<\/strong><\/p>\n

[5] Rouvi\u00e8re H. In: Anatomie humaine. Tome 1<\/em>. Paris: Masson; 1967.\u00a0<\/strong>p. 260-72.<\/strong><\/p>\n

[6] P\u00e9ri G, Mondi\u00e9 JM. Blocs nerveux de l\u2019extr\u00e9mit\u00e9 c\u00e9phalique. In:\u00a0<\/strong>Dalens B, editor. Anesth\u00e9sie locor\u00e9gionale de la naissance \u00e0 l\u2019\u00e2ge\u00a0<\/em><\/strong>adulte<\/em>. Paris: Pradel; 1993. p. 401-70.<\/strong><\/p>\n

[7] Navez M, Molliex S, Auboyer C. Les blocs de la face. In: Conf\u00e9rences\u00a0<\/em><\/strong>d\u2019actualisation de la SFAR. Paris: Elsevier; 1997. p. 237-49.<\/em><\/strong><\/p>\n

[8] Khalifa N, Bessede JP. Anatomie de la face et du cou. In: Chirurgie\u00a0<\/em><\/strong>cutan\u00e9e r\u00e9paratrice de la face et du cou<\/em>. Paris: Masson; 2003. p. 3-8.<\/strong><\/p>\n

[9] Kamina P. Pr\u00e9cis d\u2019anatomie clinique. Tome 2<\/em>. Paris: Maloine; 2004\u00a0<\/strong>(p. 90-8, 109-10, 263-5, 286-9).<\/strong><\/p>\n

[10] Murat I. Pharmacologie, anesth\u00e9siques locaux et adjuvants. In:\u00a0<\/strong>Dalens B, editor. Anesth\u00e9sie locor\u00e9gionale de la naissance \u00e0 l\u2019\u00e2ge\u00a0<\/em><\/strong>adulte<\/em>. Paris: Pradel; 1993. p. 69-106.<\/strong><\/p>\n

[11] Boogaerts J. Pharmacologie des anesth\u00e9siques locaux. In:\u00a0<\/strong>Pharmacologie en anesth\u00e9siologie<\/em>. Paris: Pradel; 1998. p. 281-312.<\/strong><\/p>\n

[12] Zetlaoui P. Quelle posologie pour la clonidine par voie p\u00e9riph\u00e9rique?\u00a0<\/strong>Ann Fr Anesth Reanim<\/span><\/em> 1998;<\/span>17<\/span>:35-6.<\/span><\/strong><\/p>\n

[13] Bouaziz H, Narchi P, Mercier FJ, Khoury A, Poirier T, Benhamou D.\u00a0<\/span><\/strong>The use of a selective axillary nerve block for outpatient hand surgery.\u00a0<\/span><\/strong>Anesth Analg<\/em> 1998;86:746-8.<\/strong><\/p>\n

[14] Jochum D, Delaunay L. La neurostimulation, le neurostimulateur et la\u00a0<\/strong>multistimulation raisonn\u00e9e. Ann Fr Anesth Reanim<\/em> 2005;24:236-8.<\/strong><\/p>\n

[15] Jochum D. Stimulateurs de nerfs : 10 ans d\u2019exp\u00e9rience. In: \u00c9valuation\u00a0<\/em><\/strong>et traitement de la douleur<\/em>. Paris: SFAR-Elsevier; 2002. p. 7-20.<\/strong><\/p>\n

[16] Delbos A, Aknin P. Neurostimulation en anesth\u00e9sie locor\u00e9gionale. In:\u00a0<\/strong>Conf\u00e9rences d\u2019actualisation de la SFAR. Paris: Elsevier; 2003.\u00a0<\/em><\/strong>p. 119-34.<\/strong><\/p>\n

[17] Les blocs p\u00e9riph\u00e9riques des membres chez l\u2019adulte. In: Recommandations\u00a0<\/em><\/strong>pour la pratique clinique<\/em>.<\/strong> Paris<\/strong><\/span>: SFAR; 2003.<\/span><\/strong><\/p>\n

[18] Zide BM, Swift R. How to block and tackle the face.<\/span> Plast Reconstr\u00a0<\/em><\/strong>Surg<\/em> 1998;101:840-51.<\/strong><\/p>\n

[19] Deleuze A, Gentili M, Vial G. Anesth\u00e9sie locor\u00e9gionale en ORL : les\u00a0<\/strong>blocs de la face. Ann Fr Anesth Reanim<\/em> 2004;23:1110-3.<\/strong><\/p>\n

[20] Molliex S, Navez M, Baylot D, Prades JM, Elkhoury Z, Auboyer C.\u00a0<\/span><\/strong>Regional anaesthesia for outpatient nasal surgery.<\/span> Br J Anaesth<\/span><\/em>1996;\u00a0<\/span><\/strong>76<\/span>:151-3.<\/span><\/strong><\/p>\n

[21] Stajcic Z, Todorovic LJ. Blocks of the foramen rotundum and the oval\u00a0<\/span><\/strong>foramen: a reappraisal of extraoralmaxillary and mandibular nerve\u00a0<\/span><\/strong>injections. Br J Oral Maxillofac Surg<\/em> 1997;35:328-33.<\/strong><\/p>\n

[22] Schwatz-Arad D, Dloev E,WilliamsW. Maxillary nerve block-Anew\u00a0<\/span><\/strong>approach using a computer-controlled anesthetic system for maxillary\u00a0<\/span><\/strong>sinus elevation procedure; a prospective study.<\/span> Quintessence Int<\/span><\/em>2004;\u00a0<\/span><\/strong>35<\/span>:477-80.<\/span><\/strong><\/p>\n

[23] Robiony M, DemitriV, Costa F, Politi M, Cugini U.Truncal anaesthesia\u00a0<\/span><\/strong>of the maxillary nerve for outpatient surgically assisted rapid maxillary\u00a0<\/span><\/strong>expansion. Br J Oral Maxillofac Surg<\/em> 1998;36:389-91.<\/strong><\/p>\n

[24] Okuda Y, Okuda K, Shinohara M, Kitajima T. Use of computed\u00a0<\/span><\/strong>tomography for maxillary nerve block in the treatment of trigeminal\u00a0<\/span><\/strong>neuralgia.<\/span> Reg Anesth Pain Med<\/span><\/em> 2000;<\/span>25<\/span>:417-9.<\/span><\/strong><\/p>\n

[25] Singh B, Srivastava SK, Dang R.Anatomic considerations in relation to\u00a0<\/span><\/strong>the maxillary nerve block.<\/span> Reg Anesth Pain Med<\/span><\/em> 2001;<\/span>26<\/span>:507-11.<\/span><\/strong><\/p>\n

[26] Kim HK, Lee YS, Kho HS, Yum KW, Chung SC. Facial and glossal\u00a0<\/span><\/strong>distribution of anaesthesia after inferior alveolar nerve block.<\/span> J Oral\u00a0<\/span><\/em><\/strong>Rehabil<\/span><\/em> 2003;<\/span>30<\/span>:189-93.<\/span><\/strong><\/p>\n

[27] Salam GA. Regional anesthesia for office procedures: part I, head and\u00a0<\/span><\/strong>neck surgeries.<\/span> Am Fam Physician<\/span><\/em> 2004;<\/span>69<\/span>:585-90.<\/span><\/strong><\/p>\n

[28] Kohase H, Umino M, Shibaji T, Suzuki N. Application of a mandibular\u00a0<\/span><\/strong>nerve block using an indwelling catheter for intractable cancer pain.\u00a0<\/span><\/strong>Acta Anaesthesiol Scand<\/span><\/em> 2004;<\/span>48<\/span>:382-3.<\/span><\/strong><\/p>\n

[29] Umino M, Kohase H, Idegushi S, Sakurai N. Long-term pain control in\u00a0<\/span><\/strong>trigeminal with local anesthetics using an indwelling catheter in the\u00a0<\/span><\/strong>mandibular nerve.<\/span> Clin J Pain<\/span><\/em> 2002;<\/span>18<\/span>:196-9.<\/span><\/strong><\/p>\n

[30] Kohase H, Miyamoto T, Umino M. A new method of continuous\u00a0<\/span><\/strong>maxillary nerve block with an indwelling catheter.<\/span> Oral Surg Oral Med\u00a0<\/span><\/em><\/strong>Oral Pathol Oral Radiol Endod<\/span><\/em> 2002;<\/span>94<\/span>:162-6.<\/span><\/strong><\/p>\n

[31] Slavin KV, Wess C. Trigeminal branch stimulation for intractable\u00a0<\/span><\/strong>neuropathic pain: technical note. Neuromodulation<\/em> 2005;8:7-13.<\/strong><\/p>\n

[32] Takemura H, Masuda Y, Yatsushiro R, Yamamoto N, Hosoyamada A.\u00a0<\/span><\/strong>Mandibular nerve block treatment for trismus associated with hypoxicischemic\u00a0<\/span><\/strong>encephalopathy.<\/span> Reg Anesth Pain Med<\/span><\/em> 2002;<\/span>27<\/span>:313-5.<\/span><\/strong><\/p>\n

[33] Adam P, Perchenet-Munoz S, Moreau A, Huet P, Piot B, Mercier J.\u00a0<\/strong>Limitation d\u2019ouverture buccale par fibrose musculaire apr\u00e8s anesth\u00e9sie\u00a0<\/strong>locor\u00e9gionale. Rev Stomatol Chir Maxillofac<\/em> 1995;96:166-77.<\/strong><\/p>\n

Pour en savoir plus<\/strong><\/p>\n

Site Internet de l\u2019Anesth\u00e9sie locor\u00e9gionale francophone : www.alrf.asso.fr<\/a>.<\/strong><\/p>\n

A. Pulcini, Praticien hospitalier (pulcini.a@chu-nice.fr<\/span>).<\/strong><\/p>\n

J.-P. Guerin, Praticien hospitalier.<\/strong><\/p>\n

S. Sibon, Chef de clinique-assistant.<\/strong><\/p>\n

D\u00e9partement d\u2019anesth\u00e9sie r\u00e9animation Est (Pr D. Grimaud), CHU H\u00f4pital Saint-Roch, 5, rue P. D\u00e9voluy, 06000 Nice, France.<\/strong><\/p>\n

T. Balaguer, Praticien hospitalier.<\/strong><\/p>\n

Service de chirurgie r\u00e9paratrice, plastique, esth\u00e9tique et chirurgie de la main (Pr E. Lebreton, CHU H\u00f4pital Saint-Roch, 5, rue P. D\u00e9voluy, 06000 Nice,<\/strong><\/p>\n

France.<\/strong><\/p>\n

C. Ichai, Professeur des Universit\u00e9s, praticien hospitalier.<\/strong><\/p>\n

D\u00e9partement d\u2019anesth\u00e9sie r\u00e9animation Est (Pr D. Grimaud), CHU H\u00f4pital Saint-Roch, 5, rue P. D\u00e9voluy, 06000 Nice, France.<\/strong><\/p>\n

Toute r\u00e9f\u00e9rence \u00e0 cet article doit porter la mention : Pulcini A., Guerin J.-P., Sibon S., Balaguer T., Ichai C. Blocs de la face. EMC (Elsevier Masson SAS, Paris),<\/strong><\/p>\n

Anesth\u00e9sie-R\u00e9animation, 36-326-L-10, 2007.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Complications L\u00e9sions et br\u00e8ches vasculaires. Accidents\u00a0toxiques Tous les nerfs sont accompagn\u00e9s d\u2019un p\u00e9dicule art\u00e9riel (nerfs\u00a0supra- et infraorbitaire) ou proches d\u2019un axe art\u00e9riel important\u00a0(nerf mandibulaire et art\u00e8re maxillaire). Seul le nerf maxillaire\u00a0au trou rond est au-dessus des vaisseaux. Une approche par\u00a0neurostimulation va r\u00e9duire fortement le risque de plaie\u00a0art\u00e9rielle. Pour r\u00e9duire le risque toxique par injection intravasculaire\u00a0(mais […]<\/p>\n","protected":false},"author":8,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[56],"tags":[],"class_list":["post-4009","post","type-post","status-publish","format-standard","hentry","category-biologie-fr"],"_links":{"self":[{"href":"https:\/\/taysirassistance.tn\/fr\/wp-json\/wp\/v2\/posts\/4009","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/taysirassistance.tn\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/taysirassistance.tn\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/taysirassistance.tn\/fr\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/taysirassistance.tn\/fr\/wp-json\/wp\/v2\/comments?post=4009"}],"version-history":[{"count":1,"href":"https:\/\/taysirassistance.tn\/fr\/wp-json\/wp\/v2\/posts\/4009\/revisions"}],"predecessor-version":[{"id":4010,"href":"https:\/\/taysirassistance.tn\/fr\/wp-json\/wp\/v2\/posts\/4009\/revisions\/4010"}],"wp:attachment":[{"href":"https:\/\/taysirassistance.tn\/fr\/wp-json\/wp\/v2\/media?parent=4009"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/taysirassistance.tn\/fr\/wp-json\/wp\/v2\/categories?post=4009"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/taysirassistance.tn\/fr\/wp-json\/wp\/v2\/tags?post=4009"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}