Nerve Block: Mental: Difference between revisions

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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==
==Indications==
 
*Trauma or need to perform painful procedure on area innervated by mental nerve
 
 
 
* The mental nerve innervates the skin of the chin and mucous membranes of the lower lip, 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
* Use block to repair laceration of lower lip or soft tissues of the chin that extend from lip anteriorly to alveolar process and to the mid body of the mandible


==Contraindications==
==Contraindications==
 
*Infection overlying injection site
 
*Previous allergic reaction to local anesthesic used
 
*Distortion of anatomic landmarks
 
* allergic reaction to the type of anesthesia you are going to administer
* non-cooperative patient
* overlying skin infection


==Equipment Needed==
==Equipment Needed==
 
*Local anesthesic
 
*Chloraprep
 
*Syringe with blunt fill needle and 27ga (or 25ga) needle
 
* topical anesthesia
* viscous lidocaine
* LET
* local anesthesia
* lidocaine 1% (lasts 30-60 minutes or longer if given with epi, rapid onset)
* Mepivacaine 3% (lasts 45-90 minutes, slower onset)  
* Bupivacaine 0.5% (lasts 2-4 hours, slowest in onset)
* 18 gauge needle to draw up anesthetic
* 25 or 27 gauge needle
* 6 cc syringe
* gauze pads
* good light source
   
   
==Procedure==
==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  
* Place patient in semi-recumbent position
*Insert the needle along the lower gum into the buccal fold between the premolar teeth without placing the needle directly into the foramen
* apply topical anesthesia
*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)  
* draw up 2-5cc of anesthetic into syringe
*For lacerations over the midline, block the mental nerve on each side of the face to anesthetize crossover fibers
* locate the mental foramen by retracting the cheek laterally and palpating between the 2 lower premolar teeth  
*Block may also be performed extraorally by palpating and approaching the mandible slightly laterally to make contact just outside the mental foramen
* 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)  


==Complications==
==Complications==
*Bleeding
*Infection
*Pain
*Needle fracture
*Neuropraxia


==See Also==
*[[Nerve blocks (main)]]
*[[Local anesthetic systemic toxicity]]


 
==References==
 
<references/>
* bleeding
*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
* infection
* pain
* needle fracture
* neurapraxia
 
==Source==
 
 
emedicine
 
 
 


[[Category:Procedures]]
[[Category:Procedures]]
[[Category:ENT]]

Latest revision as of 18:48, 17 April 2024

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
  • Block may also be performed extraorally by palpating and approaching the mandible slightly laterally to make contact just outside the mental foramen

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
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