Mandibular Block

Published on 06/02/2015 by admin

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Last modified 06/02/2015

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22 Mandibular Block

Perspective

This block is most often used for diagnosis of facial neuralgias; however, it can be used for surgical procedures on the skin overlying the lower jaw, except at the jaw’s angle. Dental procedures on the lower jaw can also be carried out, although dentists more commonly use the intraoral approach to the mandibular nerve to perform this block.

Patient Selection

Patients appropriate for this block are those with facial neuralgias and those with significant cardiopulmonary disease who require a surgical procedure in the region innervated by the mandibular nerve.

Pharmacologic Choice

Because small volumes (5 mL) of local anesthetic will produce regional block of the mandibular nerve, virtually any local anesthetic agent is an acceptable choice.

Placement

Anatomy

The mandibular nerve is a mixed motor-sensory nerve, although it is primarily sensory. It exits from the cranium through the foramen ovale and parallels the posterior margin of the lateral pterygoid plate as it descends inferiorly and laterally toward the mandible (Figs. 22-1 and 22-2). The anterior division of the mandibular nerve is principally motor and supplies the muscles of mastication, whereas the posterior division is principally sensory and supplies the skin and mucous membranes overlying the lower jaw and skin anterior and superior to the ear (Fig. 22-3).

Figure 22-1.

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