Nerve Block: Mental

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Background

  • Mental nerve innervates the skin of the chin and mucous membranes of the lower lip (from lip anteriorly to alveolar process and to the mid body of the mandible) - by blocking this nerve you can have adequate anesthesia for complicated laceration closures
  • NOTE: this block does NOT anesthetize the teeth or mandibular soft tissue (see Nerve Block: Inferior Alveolar)

Indications

  • Trauma or need to perform painful procedure on area innervated by mental nerve

Contraindications

  • Infection overlying injection site
  • Previous allergic reaction to local anesthesic used
  • Distortion of anatomic landmarks

Equipment Needed

  • Local anesthesic
  • Chloraprep
  • Syringe with blunt fill needle and 27ga (or 25ga) needle

Procedure

  • Obtain informed consent
  • Place patient in semi-recumbent position
  • Draw up 2-5cc of anesthetic into syringe
  • Locate the mental foramen by retracting the cheek laterally and palpating between the 2 lower premolar teeth
  • Insert the needle along the lower gum into the buccal fold between the premolar teeth without placing the needle directly into the foramen
  • Aspirate; if no blood, inject a few cc's of anesthetic slowly (avoid injecting directly into the foramen as to prevent damage to the neurovascular bundle)
  • For lacerations over the midline, block the mental nerve on each side of the face to anesthetize crossover fibers

Complications

  • Bleeding
  • Infection
  • Pain
  • Needle fracture
  • Neuropraxia

See Also

References

  • Amsterdam J and Kilgore K. Regional Anesthesia of the Head and Neck. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014