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Anatomic considerations in relation to the mandibular nerve block

B Singh1, S K Srivastava, R Dang

  • 1Department of Anaesthesia and Anatomy, Medical College and Hospital, Rohtak, India.

Regional Anesthesia
|May 1, 1993
PubMed
Summary
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For mandibular nerve blocks, advance the needle slightly beyond the lateral pterygoid plate based on patient nerve response, not just anatomical landmarks. This study suggests a minimal needle advancement for effective mandibular nerve anesthesia.

Area of Science:

  • Anatomy
  • Anesthesiology
  • Surgical Procedures

Background:

  • Accurate needle placement is crucial for effective mandibular nerve blocks.
  • Standard textbooks often recommend specific needle advancement distances beyond anatomical landmarks.
  • Variability in nerve proximity to landmarks necessitates precise technique evaluation.

Purpose of the Study:

  • To determine the optimal needle advancement beyond the lateral pterygoid plate for mandibular nerve anesthesia.
  • To compare clinical findings with osteologic measurements for mandibular nerve block accuracy.
  • To refine guidelines for needle insertion depth in mandibular nerve blocks.

Main Methods:

  • A patient study measured distances from the zygomatic arch to the lateral pterygoid plate and the point of mandibular nerve paresthesia.

Related Experiment Videos

  • An osteologic study measured distances from the zygomatic arch to the lateral pterygoid plate and the foramen ovale in dry skulls.
  • 74 patients undergoing mandibular nerve blocks and 76 dry skulls were analyzed.

    • Main Results:

    • In patients, the mandibular nerve paresthesia point was 0.07 cm (right) and 0.11 cm (left) beyond the lateral pterygoid plate.
    • In skulls, the foramen ovale was 0.08 cm (right) and 0.07 cm (left) medial to the lateral pterygoid plate.
    • Clinical findings indicate a slight, variable advancement is needed beyond the lateral pterygoid plate.

    Conclusions:

    • Osteologically, there is no basis to advance the needle significantly past the lateral pterygoid plate.
    • Clinically, a small advancement (0.07-0.11 cm) is suggested based on patient paresthesia to ensure mandibular nerve contact.
    • Caution is advised when advancing the needle beyond the lateral pterygoid plate during mandibular nerve blocks, as recommended depths in textbooks may be excessive.