Have you had this happen to you? After administration of a textbook-perfect inferior alveolar nerve block (IANB), the patient experiences anesthesia in most areas, but not in a certain spot. For example, everywhere was pain-free except for the molar buccal tissue, or the mesial surfaces of the first molar.
Below is a table of common localized areas that may still have sensation even after the IANB injection and how to troubleshoot anesthetizing these supplementary or branching nerves. Check out our video above for a review of the landmarks for a perfect IANB technique.
Every patient's anatomy is so different, and we can’t see underlying anomalies that may also be preventing anesthesia diffusion. These include bifurcated nerves, smaller lumens, muscles, facia, and excess bone. Other options for injections would be the Gow Gates or Vazirani-Akinosi techniques, which place the needle higher up on the nerve trunk and block accessory nerves before they branch.
(Table adapted from Malamed SF, Handbook of Local Anesthesia; Bassett KB, DiMarco AC, Naughton DK. Local Anesthesia for Dental Professionals)
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