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Gow Gates Mandibular

Nerve Block

Introduction
The Gow-Gates mandibular nerve block is a true mandibular
block, since it anesthetizes almost the entire mandibular
division of the trigeminal nerve
Thus, the nerves anesthetized with a Gow-Gates mandibular
nerve block are the inferior alveolar, mental, incisive, lingual,
mylohyoid, auriculotemporal, and buccal (long) nerves in
about 75% of patients

Target Area
Neck of condyle, below insertion of lateral pterygoid muscle

Site
The injection site intraorally is on the mucosa on the mesial
of the mandibular ramus, just distal to the height of the
mesiolingual cusp of the maxillary second molar, following a
line extraorally from the intertragic notch of the ear to the
labial commissure of the same side

Gow-Gates Mandibular Block


Technique
Coordinate intraoral & extraoral landmarks
Align barrel of syringe over premolars and with extraoral
landmarks

Gow-Gates Mandibular Block


Technique (cont.)
Penetrate mucosa distal to 2nd molar
Advance needle to bone (avg. 25 mm)
Aspirate, deposit 1.8 ml of solution slowly

Gow-Gates Mandibular Block


Technique (cont.)
Patients mouth must be fully open during injection and for
1-2 minutes afterward
May require reinforcement with second injection

With the mouth open, the condyle can assume a more frontal
position, bringing the injection site closer to the mandibular
nerve trunk. With the mouth less open, the condyle will move
out of the injection site and the soft tissue become thicker.

Disadvantages
The amount of time before the anesthetic takes effect; a
Gow-Gates injection takes longer to work because the nerve
trunk being anesthetized is larger, and farther from the site of
deposition
Anesthetization of the lower lip, as well as the temporal area.

Complications
Hematoma
Trismus

Vazirani Akinosi
Mandibular Nerve Block

Akinosi Closed Mouth Mandibular


Block
Alternative for mandibular block when limited opening is
present
( e.g.. Trismus, closed lock, etc..)

Akinosi Closed Mouth Mandibular


Block
Target Area
Soft tissue medial to ramus
Above foramen, below condyle
Landmarks
Mucogingival junction of maxillary 2nd or 3rd molar
Maxillary tuberosity

Akinosi Closed Mouth Mandibular


Block
Area of insertion
Soft tissue overlying medial ramus, adjacent to tuberosity
At height of mucogingival junction of maxillary 2nd or 3rd
molar

Akinosi Closed Mouth Mandibular


Block
Technique
Retract soft tissues, have patient occlude
Apply topical
Penetrate to 25 mm, parallel to maxillary occlusal plane, in a
posterior and lateral direction

Akinosi Closed Mouth Mandibular


Block
Technique (cont.)
Aspirate, deposit 1.8 ml slowly
Motor paralysis will develop first, allowing patient to open
more widely

Akinosi Closed Mouth Mandibular


Block
Advantages
Not necessary to open widely
High success rate
Relatively atraumatic
Few complications, few positive aspirations

Akinosi Closed Mouth Mandibular


Block
Disadvantages
Visualization of path and depth of insertion is difficult
No bony contact
Traumatic if needle hits periosteum

Akinosi Closed Mouth Mandibular


Block
Complications
Hematoma (<10%)
Facial nerve paralysis (Bells Palsy)
Trismus (rare)

Akinosi Closed Mouth Mandibular


Block
Failures of anesthesia
Lateral flaring of mandible
Insertion too low
Penetration too deep or shallow (adjust for patient size)