Buccal nerve block

Overview

Distribution schemes of the trigeminal nerve.

Dissection showing branches of the mandibular nerve.

Dental Anesthesia

• Also known as long buccal nerve block
• Provides buccal soft tissue anesthesia adjacent to mandibular molars

Indications

• Soft-tissue injury to buccal soft-tissue
• Gingival pain not relieved with inferior alveolar block ('See also' below)

Contraindications

• Allergy to anesthetic
• Infection overlying site

Equipment Needed

• Anesthetic (see below)
• 5mL or 10mL syringe
• Blunt fill or 18 gauge needle
• 25-27 gauge needle
• Gauze
• Long cotton tipped applicators
• Personal protective equipment (non-sterile gloves and eye protection)
• Bite block if necessary
  • If bite block unavailable, may use 5-10 (or more) tongue depressors taped together as improvised bite block
• Appropriate, dedicated lighting such as an overhead lamp

Procedure

Preparation

• Place patient in supine if tolerated or seated with as much recumbency as tolerated
• Position yourself contralateral to target
• Consider use of topical anesthetic
  • Method 1: Swish and spit viscous lidocaine in mouth for at least 30 seconds
  • Method 2: Soak gauze or cotton tipped applicators with viscous or regular lidocaine and place them at target for 1-5 minutes

Injection

• Area of insertion: mucous membrane distal and buccal to distal molar
• Target Area: buccal nerve as it passes anterior ramus of the mandible

1. Identify and/or palpate landmarks: mandibular molars, mucobuccal fold
2. Orient needle so it is parallel to occlusal surfaces of the teeth with bevel towards the bone
3. Advance needle until bone is felt
4. Inject 1-2cc of anesthetic

Special Considerations

• Consider use of additional support for distraction, especially for pediatric or highly anxious patients (child-life specialists, parental coaching, iPad or cell-phone videos etc)
• Approach with needle from mandibular side to reduce patient's visibility of needle
• Avoid cold/refrigerated anesthetic to reduce pain or allow time for anesthetic to warm to room temperature

Complications

• Unintentional biting of soft-tissue by patient
• Hematoma/bleeding
• Pain

See Also

• Nerve Block: Inferior Alveolar

External Links

• NUEM Oral Block blog post: https://www.nuemblog.com/blog/oral-nerve-blocks
• Dr. Zibran OMFS Lecture: https://www.youtube.com/watch?v=ILzRM73VVH0