Transcutaneous Mandibular Nerve Blocks – Success Rate Between Two Techniques

Background and Overview: Success rates to achieve profound pulpal anesthesia of the mandibular teeth using the traditional inferior alveolar nerve block technique have been reported by several authors to be 80-85%¹. The Gow-Gates and Akinosi-Vazirani techniques have also been reliable alternatives to achieve inferior alveolar nerve anesthesia, through an intraoral approach. The purpose of this study was to compare the efficacy of two, well-documented, extraoral techniques in their ability to anesthetize the dental pulp of mandibular teeth. The technique described by Kantorowicz delivers local anesthetic within the ptergyomandibular space adjacent to the mandibular foramen by inserting the needle in a transcutaeous fashion in the submandibular region along the medial aspect of the mandible. Braun’s technique describes the injection of anesthetic solution near the foramen ovale by inserting the needle along the inferior aspect of the zygomatic arch at its midpoint; then, after touching the pterygoid process and reangulating the needle posteriorly, V3 anesthesia will take place. These techniques could be part of the armamentarium used by dental practitioners to provide treatment comfortably in the mandibular arch.

Materials and Methods: Following approval from The Ohio State University IRB, 80 ASA I and II patients requiring bilateral mandibular tooth extractions under general anesthesia and deep sedation were enrolled over a period of 6 months. All patients received bilateral mandibular nerve blocks, one side using the Kantorowicz technique and the other side using the Braun technique. Patients were randomly assigned to one of two groups; group A received the Kantorowicz injection on the right, group B received this technique on the left. The anesthetic used was 3.0mL of 2% Lidocaine with 1:100,000 parts of epinephrine. The pulpal anesthesia success was measured by applying a standardized method described by Vreeland and Reader². The anesthetic success of both groups was analyzed using nonparametric chi-square tests.

Results: Preliminary study results show no difference between the administration of either extraoral technique in order to achieve pulpal anesthesia. This study is still in progress, and will be expected to conclude in August 2013.

Conclusions: Both the Kantorowicz and Braun extraoral techniques to achieve mandibular pulpal anesthesia are excellent adjuncts to the armamentarium of the dental practitioner. There is reduced need for patient cooperation: open their mouth maximally, accurately position their tongue, and keep absolutely still.

1. Malamed SF. Techniques of Mandibular Anesthesia. In: Handbook of Local Anesthesia. 5th ed. St. Louis: Elsevier Mosby; 2004: 227.
2. Vreeland DL, Reader A, Beck M, Meyers W, Weaver J. An Evaluation of Volumes and Concentrations of Lidocaine in Human Inferior Alveolar Nerve Block. J Endo 1989; 6-7.