Buccal nerve block

oral surgery

1. Buccal nerve block The buccal nerve is a branch of the anterior division of V3 and consequently is not anesthetized during IANB.

2. Other names – long buccal nerve block, buccinator nerve block . Nerve anesthesia – buccal (a branch of the anterior division of the V3). Area anesthetized – soft tissues and periosteum buccal to the mandibular molar teeth. Indications –when buccal soft tissues anesthesia is necessary for dental procedures in the mandibular molar regions. Contraindications- infection or acute inflammation in the area of injection. Advantages – high success rate , technically easy. Disadvantages – potential for pain if the needle contacts the periosteum during injection.

3. Alternatives- Buccal Infiltration , Gow –Gates mandibular nerve block, Vazirani – Akinosi mandibular nerve block , PDL injection , Intraosseous injection , Intraseptal injection . Technique- 25 or 27 gauge long needle is recommended . Area of insertion – mucous membrane distal and buccal to the most distal molar tooth in the arch. Target area – buccal nerve as it passes over the anterior border of the ramus. Landmarks – mandibular molars, mucobuccal fold . Orientation of the bevel – toward bone during the injection.

4. Signs and symptoms – because of the location and small size of the anesthetized area, the patient rarely experiences any subjective symptoms. Objective – instrumentation in the anesthetized area without pain indicates satisfactory pain control. Safety features- 1. needle contacts bone , therein preventing overinsertion . 2. minimum positive aspiration rate . Precautions –pain on insertion from contacting the unanesthetized periosteum. This can be prevented by depositing a few drops of local anesthetic before touching the periosteum. Local anesthetic solution not being retained at the injection site. This generally means that needle penetration is not deep enough, the bevel of the needle is partially in the tissues, and solution is escaping during injection.

5. Failures of anesthesia – rare with the buccal nerve block: inadequate volume of anesthetic retained in the tissues. Complications- 1. few of any consequence, 2. hematoma (bluish discoloration and tissue swelling at the injection site). Blood may exit the needle puncture point into the buccal vestibule . To treat : apply pressure with gauze directly to the area of bleeding for a minimum of 3 to 5 min.