Superior position of the mandibular foramen and the necessary alterations in the local anaesthetic technique: a case report

Holliday, Richard; Jackson, I.

doi:10.1038/sj.bdj.2011.145

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…This is because the mandible is the most variable bone of the body, and it can be difficult to locating the mandibular foramen. 10 Sixty-seven men and women were included in this study. A total of 117 tooth extractions were evaluated in order to assess the rate of anaesthetic failure with the inferior alveolar nerve block, and to discuss the most suitable alternative technique for each case of failure.…”

Section: Discussionmentioning

confidence: 99%

Failure rate of pterygomandibular block in lower third molar extraction procedures

Sánchez¹,

Conforte²,

Bonardi³

et al. 2018

Arch Health Invest

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The aim of this study was to evaluate the anaesthetic failure rate of the pterygomandibular technique with an inferior alveolar nerve block in lower third molar extraction procedures. Materials and Methods: A total of 67 healthy patients (men and women, aged between 18-35 years) requiring third molar extractions were selected from the Discipline of Surgery, of the Araçatuba Dental School. The anaesthetic technique utilised was a pterygomandibular block using 2% mepivacaine hydrochloride with epinephrine 1:100,000 (Mepivalem®) in a maximum standardised amount of three tubes (5.4 ml) per procedure (performed by the same operator). Surgical procedures were initiated after confirming the sensation of anaesthesia in the area anesthetised at the inferior alveolar nerve. Painful symptoms were recorded during surgery. Results: In total, 117 surgical procedures, i.e., 114 exodontias and three coronectomies, were performed. During surgical procedures, four patients reported pain during manoeuvres of odontosection, representing an anaesthetic failure rate of 3.41%. Alternative techniques utilised in these four patients involved milohioideo nerve, intraligamentaria, and intrapulpal anaesthesia. Conclusion: The success of inferior alveolar nerve block anaesthesia is difficult to predict due to large anatomical variations, and it is difficult to observe via diagnostic means. The relatively low percentage of anaesthetic failure reported in this study may be related to the number of procedures performed. Descriptors: Anesthesia, Dental; Anesthesia, Local; Molar, Third. Resumo O objetivo deste estudo foi avaliar a taxa de falha anestésica da técnica pterigomandibular com bloqueio do nervo alveolar inferior em procedimentos de extração do terceiro molar inferior. Material e Método: um total de 67 pacientes saudáveis (homens e mulheres, com idade entre 18-35 anos) que requeriam extrações do terceiro molar foram selecionados da Disciplina de Cirutgia da Faculdade de Odontologia de Araçatuba. A técnica anestésica utilizada foi um bloqueio pterigomandibular usando cloridrato de mepivacaína a 2% com epinefrina 1: 100,000 (Mepivalem®) em uma quantidade máxima padronizada de três tubos (5,4 ml) por procedimento (realizado pelo mesmo operador). Os procedimentos cirúrgicos foram iniciados após confirmação da sensação de anestesia na área anestesiada no nervo alveolar inferior. Sintomas dolorosos foram registrados durante a cirurgia. Resultados: No total, foram realizados 117 procedimentos cirúrgicos, isto é, 114 exodontias e três coronectomias. Durante os procedimentos cirúrgicos, quatro pacientes relataram dor durante as manobras de odontossecção, representando uma taxa de falha anestésica de 3,41%. As técnicas alternativas utilizadas nesses quatro pacientes envolveram nervo milohioideo, intraligamentar e anestesia intrapulpar. Conclusão: o sucesso da anestesia com bloqueio do nervo alveolar inferior é difícil de prever devido a grandes variações anatômicas e é difícil de observar por meio de meios diagnósticos. A porcentagem relativament...

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Section: Discussionmentioning

confidence: 99%

Failure rate of pterygomandibular block in lower third molar extraction procedures

Sánchez¹,

Conforte²,

Bonardi³

et al. 2018

Arch Health Invest

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“…The variant nerve is in the pathway of Gow‐Gates and Vazirani‐ Akinosi techniques of the IANBA and hence may be traumatized during the procedure. On the other hand, if conventional (Halstead) technique of the IANBA fails, use of Gow‐Gates technique which anesthetizes several branches of the mandibular nerve including the inferior alveolar nerve, should also take care of the variant branch, if it is present (Holliday and Jackson, 2011).…”

Section: Discussionmentioning

confidence: 99%

A recurrent variant branch of the inferior alveolar nerve: Is it unique?

Buch

Agnihotri

2012

Clinical Anatomy

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The only named branch of the inferior alveolar nerve (IAN) before it enters the mandibular foramen is the mylohyoid nerve. However, several variations have been reported in the literature. In this study, a recurrent variant branch of the IAN arising just below the origin of the mylohyoid nerve was investigated in adult Indian cadavers allotted for dissection to the first year dental students of Government Dental College, Ahmedabad (India). The dissection was performed by the lateral approach to the infratemporal fossa. The nerve was found in 12 of 35 sides (34.3%) and 8 of 18 cadavers (44.4%). Thus, in our study it was not a rare variation of the IAN, where in most cases it innervated the lateral pterygoid muscle. In some cases, it terminated in the lateral pterygoid muscle. In others, it penetrated the muscle to join the anterior or posterior division of the mandibular nerve or its branches; thus, the variant nerve in such cases might be regarded as an additional root of the IAN. Because the concerned primordia of the nerves and muscles migrate extensively during development and growth, alternative routes of migration may bring about variants like the one under study. The variant appeared to be unique in some of its features. It may be a source of neuropathic and referred pain. Failure of the conventional inferior alveolar nerve block anesthesia and the peripheral neurectomy used for the treatment of trigeminal neuralgia may be partly due to the presence of this variation.

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“…[13] The foramen can also be superior to its normal anatomical location. [17] Although published reports point to some differences in the location of the mandibular foramen, these differences are not large and the deposition of local anesthetic solution can overcome these differences by diffusion. Figure 2 shows the common location of the mandibular foramen in relation to the ramus height and width, to the occlusal plane, and to the target area of the conventional inferior alveolar nerve block technique.…”

Section: Basic Anatomymentioning

confidence: 99%

A basic review on the inferior alveolar nerve block techniques

Khalil

2014

Anesth Essays Res

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The inferior alveolar nerve block is the most common injection technique used in dentistry and many modifications of the conventional nerve block have been recently described in the literature. Selecting the best technique by the dentist or surgeon depends on many factors including the success rate and complications related to the selected technique. Dentists should be aware of the available current modifications of the inferior alveolar nerve block techniques in order to effectively choose between these modifications. Some operators may encounter difficulty in identifying the anatomical landmarks which are useful in applying the inferior alveolar nerve block and rely instead on assumptions as to where the needle should be positioned. Such assumptions can lead to failure and the failure rate of inferior alveolar nerve block has been reported to be 20-25% which is considered very high. In this basic review, the anatomical details of the inferior alveolar nerve will be given together with a description of its both conventional and modified blocking techniques; in addition, an overview of the complications which may result from the application of this important technique will be mentioned.

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Superior position of the mandibular foramen and the necessary alterations in the local anaesthetic technique: a case report

Cited by 10 publications

References 23 publications

Failure rate of pterygomandibular block in lower third molar extraction procedures

Failure rate of pterygomandibular block in lower third molar extraction procedures

A recurrent variant branch of the inferior alveolar nerve: Is it unique?

A basic review on the inferior alveolar nerve block techniques

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