Study design

Prospective experimental cadaveric study.

Animals

A total of 13 Beagle Cross cadaver heads.

Methods

After describing the ultrasound bony landmarks and posterior extraconal local regional technique in one head, 12 heads were used to evaluate the spreading of contrast and evaluate potential complications. A 5–8 MHz microconvex ultrasound probe was positioned caudal to the orbital ligament, with the beam orientated transversely, and then tilted caudally until the orbital fissure was visualized. After identifying the bony structures consistent with the orbital fissure, a needle was advanced using an in-plane technique and 0.5 mL of a 50:50 mixture of iohexol and methylene blue was injected. Computed tomography (CT) and dissection were used to evaluate successful injections and potential complications. The injection was considered successful if radiopaque contrast medium was 5 mm from the orbital fissure. Potential complications were defined as the presence of radiopaque contrast within the globe or the intracalvarial tissues.

Results

The CT images confirmed contrast at the target site in 15/24 (63%) of the injections. Only two injections were found in the temporalis muscle; the rest of the injections were located in the extraconal space. No potential complications such as intracranial spreading of contrast, intravascular or intraocular injection were found.

Conclusions and clinical relevance

The technique can deliver contrast close to the main nerves which provide sensory and motor innervation to the eye. Further studies are needed to evaluate this technique in clinical cases.