Local and regional anesthesia techniques, Part 3: Blocking the maxillary and mandibular nerves - Veterinary Medicine
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Local and regional anesthesia techniques, Part 3: Blocking the maxillary and mandibular nerves
These easy-to-perform techniques will help ease the pain of tooth extractions and other oral surgeries in your patients.


VETERINARY MEDICINE


MENTAL AND MANDIBULAR (INFERIOR ALVEOLAR) NERVE BLOCKS


2. The position of the needle to block the mental branch of the mandibular nerve at the rostral mental foramen in dogs and cats to provide anesthesia rostral to the foramen.
Blocking the mental branch of the mandibular nerve as it exits the largest and most rostral of the mental foramina (Figure 2) anesthetizes the lower incisors and skin and tissues rostral to the foramen.2,3 Insert the needle intraorally or percutaneously, parallel to the teeth, just rostral to the mental foramen. The mental foramen is caudal and ventral to the canine tooth. Advance the needle 1 to 2 mm into the foramen in dogs, but do not advance it into the canal in cats. After test aspiration, apply digital pressure during injection to facilitate movement of the drug into the foramen.


3. The position of the needle to block the inferior alveolar branch of the mandibular nerve at its point of entry into the mandibular canal at the mandibular foramen in dogs and cats. This block will provide anesthesia to the entire hemimandible, including the teeth.

4. A medial view of the point of entry of the inferior alveolar branch of the mandibular nerve into the mandibular foramen in a dog.
Blocking the inferior alveolar branch of the mandibular nerve at its point of entry into the mandibular canal at the mandibular foramen anesthetizes the entire hemimandible and more reliably anesthetizes the teeth of the lower jaw (Figures 3 & 4).2,3 Insert the needle percutaneously at the ventral angle of the mandible, slightly rostral to the angular process, and advance it dorsally, against the medial surface of the ramus, to the palpable lip of the mandibular foramen. Inject the local anesthetic after test aspiration. The nerve and needle can usually be palpated with a finger from inside the mouth, making placement of the local anesthetic more successful.

Christine Egger, DVM, MVSc, DACVA
Lydia Love, DVM
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
The University of Tennessee
Knoxville, TN 37996

REFERENCES

1. Scarda RT, Tranquilli WJ. Local anesthetics; Local and regional anesthetic techniques: dogs; Local and regional anesthetic techniques: cats. In: Lumb and Jones' veterinary anesthesia and analgesia. 4th ed. Tranquilli WJ, Thurmon JC, Grimm KA, eds. Iowa, Ames: Blackwell Publishing, 2007;395-418, 561-604.

2. Lemke KA. Pain management II: local and regional anaesthetic techniques. In: Seymour C, Duke-Novakovski T, eds. BSAVA manual of canine and feline anaesthesia and analgesia. 2nd ed. Gloucester, UK: British Small Animal Veterinary Association, 2007;104-114.

3. Gaynor JS, Mama KR. Local and regional anesthetic techniques for alleviation of perioperative pain. In: Gaynor J, Muir W, eds. Handbook of veterinary pain management. St Louis, Mo: Mosby, 2002;261-280.


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