Nerve Block: Mental: Difference between revisions

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==Equipment Needed==
==Equipment Needed==
#topical anesthesia
*Local anesthesic
##viscous lidocaine
*Chloraprep
##LET
*Syringe with blunt fill needle and 27ga (or 25ga) needle
#local anesthesia
##lidocaine 1% (lasts 30-60 minutes or longer if given with epinephrine, rapid onset)
##Mepivacaine 3% (lasts 45-90 minutes, slower onset)
##Bupivacaine 0.5% (lasts 2-4 hours, slowest in onset)
#18 gauge needle to draw up anesthetic
#25 or 27 gauge needle
#6 cc syringe
#gauze pads
#good light source
   
   
==Procedure==
==Procedure==
#Place patient in semi-recumbent position
*Obtain informed consent
#apply topical anesthesia
*Place patient in semi-recumbent position
#draw up 2-5cc of anesthetic into syringe
*Draw up 2-5cc of anesthetic into syringe
#locate the mental foramen by retracting the cheek laterally and palpating between the 2 lower premolar teeth  
*Locate the mental foramen by retracting the cheek laterally and palpating between the 2 lower premolar teeth  
#insert the needle along the lower gum into the buccal fold between the premolar teeth without placing the needle directly into the foramen
*Insert the needle along the lower gum into the buccal fold between the premolar teeth without placing the needle directly into the foramen
#aspirate; if no blood inject a few cc's of anesthetic slowly (avoid injecting directly into the foramen as to prevent damage to the neurovascular bundle)  
*Aspirate; if no blood, inject a few cc's of anesthetic slowly (avoid injecting directly into the foramen as to prevent damage to the neurovascular bundle)  
*For lacerations over the midline, block the mental nerve on each side of the face to anesthetize crossover fibers
*Block may also be performed extraorally by palpating and approaching the mandible slightly laterally to make contact just outside the mental foramen


==Complications==
==Complications==
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*Pain
*Pain
*Needle fracture
*Needle fracture
*Neurapraxia
*Neuropraxia


==See Also==
==See Also==
*[[Nerve blocks (main)]]
*[[Nerve blocks (main)]]
*[[Local anesthetic systemic toxicity]]
*[[Local anesthetic systemic toxicity]]
==Video==
{{#widget:YouTube|id=hPALXAq9pTo}}


==References==
==References==
<references/>
<references/>
*Amsterdam J and Kilgore K. Regional Anesthesia of the Head and Neck. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014


[[Category:Procedures]]
[[Category:Procedures]]
[[Category:ENT]]
[[Category:ENT]]

Latest revision as of 22:19, 16 November 2020

Background

  • Mental nerve innervates the skin of the chin and mucous membranes of the lower lip (from lip anteriorly to alveolar process and to the mid body of the mandible) - by blocking this nerve you can have adequate anesthesia for complicated laceration closures
  • NOTE: this block does NOT anesthetize the teeth or mandibular soft tissue (see Nerve Block: Inferior Alveolar)

Indications

  • Trauma or need to perform painful procedure on area innervated by mental nerve

Contraindications

  • Infection overlying injection site
  • Previous allergic reaction to local anesthesic used
  • Distortion of anatomic landmarks

Equipment Needed

  • Local anesthesic
  • Chloraprep
  • Syringe with blunt fill needle and 27ga (or 25ga) needle

Procedure

  • Obtain informed consent
  • Place patient in semi-recumbent position
  • Draw up 2-5cc of anesthetic into syringe
  • Locate the mental foramen by retracting the cheek laterally and palpating between the 2 lower premolar teeth
  • Insert the needle along the lower gum into the buccal fold between the premolar teeth without placing the needle directly into the foramen
  • Aspirate; if no blood, inject a few cc's of anesthetic slowly (avoid injecting directly into the foramen as to prevent damage to the neurovascular bundle)
  • For lacerations over the midline, block the mental nerve on each side of the face to anesthetize crossover fibers
  • Block may also be performed extraorally by palpating and approaching the mandible slightly laterally to make contact just outside the mental foramen

Complications

  • Bleeding
  • Infection
  • Pain
  • Needle fracture
  • Neuropraxia

See Also

Video

{{#widget:YouTube|id=hPALXAq9pTo}}

References

  • Amsterdam J and Kilgore K. Regional Anesthesia of the Head and Neck. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014