Nerve Block: Inferior Alveolar

Indications

1. The inferior alveolar nerve provides sensation to all of the teeth on the ipsilateral side of the mandible as well as the lower lip and chin via blockade of the mental nerve.
2. Consider this in cases of severe dentoalveolar traum, dry socket, or periapical abscess.

Contraindications

1. Allergy to anasthesia being used
2. Overlying cellulitis at injection site
3. Non-Cooperative Patient (high risk for needle stick)

Equipment Needed

1. Topic Anesthesia
   • Consider Soaking Gauze/Cotton in Lidocaine to be placed at injection site
2. Local Anesthesia
   • Lidocaine/Mepivicaine/Bupivicaine (Shortest Onset/Shortest Duration-->Longest Onset/Longest Duration)
3. 18ga Needle for Drawing Up Anesthetic
4. 25/27ga Needle for Injection
5. 10/6cc syringe
6. Gauze
7. Light source
8. Suction

Procedure

1. Preparation
   1. Place pt in seated position or in dental chair so that when his mouth is open, the mandible is parallel to the floor
   2. Place yourself on the opposite side of the the site being injected
   3. Consider Topical Anesthetic with lidocaine soaked gauze

1. Injection
2. Palpate the retromolar fossa with your thumb
3. Place the index finger of the same hand externally over the ramus of the mandible retracting the tissues toward the buccal aspect
4. Visualize the pterygomandibular triangle
5. Hold the syringe parallel to the occlusal surfaces of the teeth and angle so that the barrel lies between the 1st/2nd premolars of the opposite side
   • If a large syringe is being used, consider bending the needle 30 degrees for this approach
6. Puncture with the needle 1cm above the occlusal surface of the molars
7. Advance the needle until bone is felt
8. Inject 1-2cc
   • Injecting as your withdraw has the added benefit of including the lingual (ant 2/3 of the tongue)

Complications

1. Inadvertent Injection of the Partoid Gland (if too lateral and posterior) which will affect the facial nerve and may result in a Bell's Palsy
2. Bleeding
3. Pain
4. Infection

See Also

• Nerve Blocks (Main)

Sources

1. Roberts, J. et al. Clinical Procedures in Emergency Medicine 6th Edition. Philadelphia: Elevier/Saunders; 2013