SPECIAL TECHNIQUES

Indication For Special Technique

Infection Pathology Trismus Trauma

Nerve Block Techniques

Extraoral Maxillary Nerve Block Extraoral Infraorbital Nerve Block Extraoral Mandibular Nerve Block

Nerve Block Techniques

Gow-Gates Mandibular Nerve Block Akinosi Closed Mouth Mandibular Nerve Block

Infiltration Techniques
Periodontal Ligament Intraosseous Mylohyoid Nerve

Gow-Gates Mandibular Block

Developed to improve success rate True mandibular nerve block Has a lower rate of positive aspiration (2% vs. 10%-15% for IAN) Technique dependent

Indication For Special Technique

Anatomic variation Complete nerve trunk Selective pulpal / soft tissue anesthesia

Gow-Gates Mandibular Block

Target Area Neck of condyle, below insertion of lateral pterygoid muscle

Gow-Gates Mandibular Block

Landmarks Mesiolingual cusp of maxillary 2nd molar Intertragic notch Corner of the mouth

Gow-Gates Mandibular Block

Technique Coordinate intraoral & extraoral landmarks Align barrel of syringe over premolars and with extraoral landmarks

Gow-Gates Mandibular Block

Technique (cont.) Penetrate mucosa distil to 2nd molar Advance needle to bone (avg. 25 mm) Aspirate, deposit 1.8 ml of solution slowly

Gow-Gates Mandibular Block

Technique (cont.) Patients mouth must be fully open during injection and for 1-2 mins afterward May require reinforcement with second injection

Gow-Gates Mandibular Block

Complications Hematoma (< 2%) Trismus

Akinosi Closed Mouth Mandibular Block

Alternative for mandibular block when limited opening is present ( eg. trismus, closed lock, etc..)

Akinosi Closed Mouth Mandibular Block

Advantages Not necessary to open widely High success rate Relatively atraumatic Few complications, few positive aspirations

Akinosi Closed Mouth Mandibular Block

Disadvantages Visualization of path and depth of insertion is difficult No bony contact Traumatic if needle hits periosteum

Akinosi Closed Mouth Mandibular Block

Target Area Soft tissue medial to ramus Above foramen, below condyle Landmarks Mucogingival junction of maxillary 2nd or 3rd molar Maxillary tuberosity

Akinosi Closed Mouth Mandibular Block

Area of insertion Soft tissue overlying medial ramus, adjacent to tuberosity At height of mucogingival junction of maxillary 2nd or 3rd molar

Akinosi Closed Mouth Mandibular Block

Technique Retract soft tissues, have patient occlude Apply topical Penetrate to 25 mm, parallel to maxillary occlusal plane, in a posterior and lateral direction

Akinosi Closed Mouth Mandibular Block

Technique (cont.) Aspirate, deposit 1.8 ml slowly Motor paralysis will develop first, allowing patient to open more widely

Akinosi Closed Mouth Mandibular Block

Complications Hematoma (<10%) Facial nerve paralysis (Bells Palsy) Trismus (rare)

Akinosi Closed Mouth Mandibular Block

Failures of anesthesia Lateral flaring of mandible Insertion too low Penetration too deep or shallow (adjust for patient size)