Alternative mandibular nerve block techniques: A review of the Gow-Gates and Akinosi-Vazirani closed-mouth mandibular nerve block techniques

https://doi.org/10.14219/jada.archive.2011.0341Get rights and content

ABSTRACT

Background and Overview

The limited success rate of the standard inferior alveolar nerve block (IANB) has led to the development of alternative approaches for providing mandibular anesthesia. Two techniques, the Gow-Gates mandibular nerve block and the Akinosi-Vazirani closed-mouth mandibular nerve block, are reliable alternatives to the traditional IANB. The Gow-Gates technique requires the patient's mouth to be open wide, and the dentist aims to administer local anesthetic just anterior to the neck of the condyle in proximity to the mandibular branch of the trigeminal nerve after its exit from the foramen ovale. The Akinosi-Vazirani technique requires the patient's mouth to be closed, and the dentist aims to fill the pterygomandibular space with local anesthetic.

Conclusion

Both techniques are indicated for any type of dentistry performed in the mandibular arch, but they are particularly advantageous when the patient has a history of standard IANB failure owing to anatomical variability or accessory innervation.

Clinical Implications

Having the skill to perform these alternative anesthetic techniques increases dentists' ability to provide successful local anesthesia consistently for all procedures in mandibular teeth.

Section snippets

GOW-GATES MANDIBULAR NERVE BLOCK

Gow-Gates6 initially described what became known as the “Gow-Gates mandibular nerve block” in 1973. The objective of the technique is to place the needle tip and administer the local anesthetic at the neck of the condyle (Figure 1). This position is in proximity to the mandibular branch of the trigeminal nerve after it exits the foramen ovale. As with the other two mandibular techniques, use a 25-gauge long needle. Before looking inside the patient's mouth, determine the extraoral landmarks.

AKINOSI-VAZIRANI CLOSED-MOUTH MANDIBULAR NERVE BLOCK

Two dentists independently described the closed-mouth mandibular nerve block as an alternative to the IANB. In 1977, Akinosi7 brought this method to the attention of educators, but they soon realized that this technique had been published by Vazirani in 1960.8 This technique has the same indications as do the IANB or Gow-Gates methods (Box 2), but it is indicated particularly if the patient has trismus or the dentist has difficulty seeing the intraoral landmarks used for the IANB.

What makes

CONCLUSIONS

Ideally, all three techniques for mandibular anesthesia should be taught to dental students. Nevertheless, use of all three techniques in practice does not necessarily follow, possibly because faculty who supervise predoctoral clinical dentistry are not familiar with the alternative techniques.18 For dentists who already are in practice, although it is difficult to learn new techniques, it is worth the challenge because the benefits are substantial. Dentists who are not comfortable using these

References (18)

There are more references available in the full text version of this article.

Cited by (0)

Disclosure. Dr. Haas did not report any disclosures.

The author thanks Andrea Cormier, Christine Nicolau, Bruno Rakiewicz and James Fiege of the Media Services Department of the Faculty of Dentistry, University of Toronto, for their skill in preparing the material used for Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6.

*

Dr. Haas is the Chapman Chair, associate dean of clinical sciences, and a professor and the head of dental anaesthesia, Faculty of Dentistry, a professor, Department of Pharmacology, Faculty of Medicine, and active staff, Sunnybrook Health Sciences Centre, University of Toronto.

View full text
Copyright © 2011 American Dental Association. Published by Elsevier Inc. All rights reserved.