Demystifying the Suprazygomatic Maxillary Nerve Block in Paediatric Cleft Palate Surgery.

Objective: To consider the clinical anatomy, safety and effectiveness of the suprazygomatic maxillary nerve block in cleft palate surgery.

Design: Observational case series.

Setting: Single cleft centre in the United Kingdom.

Participants: Patients born with a cleft palate (with or without a cleft lip) undergoing palatal surgery between the ages of 9 months and 18 years.

Intervention: Introduction of suprazygomatic maxillary nerve (SZMN) block using ropivacaine 0.2% into clinical protocol in February 2023.

Main Outcome Measures: Peri-procedure complications and post-operative opioid administration.

Results: The clinical anatomy of the SZMN block is described in a stepwise and pictorial approach from superficial to deep structures. 43 patients underwent surgical interventions involving the palate (either intravelar veloplasty, Furlow palatoplasty or bilateral myomucosal buccinator flaps for palatal lengthening). 22 patients had a general anaesthetic and local anaesthetic infiltration and 21 had an additional SZMN block. There were no local or systemic complications associated with the SZMN block. There was no difference in the total dosing of post-operative ( = .79) opioids between the groups.

Conclusions: We demonstrate the feasibility and safety of this procedure without the use of ultrasound guidance in a heterogenous group of paediatric patients undergoing palatal surgery. Regional anaesthesia should be considered as part of the multi-modal analgesic strategy, although it may be difficult to demonstrate a change in opioid use in clinical settings where enhanced recovery techniques are established, and opioid use is already low.