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AUTHOR AND EDITOR INFORMATION

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Author: Michael Lawrence Hochberg, MD, Clinical Instructor, Emergency Medicine, Albert Einstein College of Medicine; Attending, Emergency Medicine, Montefiore Medical Center

Michael Lawrence Hochberg is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Coauthor(s): Elizabeth Tillem, MD, Assistant Attending, Department of Emergency Medicine, Bronx Lebanon Hospital Center

Editors: Andrew K Chang, MD, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center; Mary L Windle, Pharm D, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine, Inc; Luis Michael Lovato, MD, Assistant Clinical Professor, David Geffen School of Medicine at UCLA, Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center; Gil Z Shlamovitz, MD, Department of Emergency Medicine, David Geffen School of Medicine, UCLA Medical Center; Rick Kulkarni, MD, Assistant Professor of Medicine, David Geffen UCLA School of Medicine; Director of Informatics, Department of Emergency Medicine, UCLA/Olive View-UCLA Medical Center

Author and Editor Disclosure

Synonyms and related keywords: mental nerve block, mental nerve, facial blocks, chin lacerations, lower lip lacerations, chin anesthesia, lower lip anesthesia, mental foramen, lip laceration, lip laceration repair, chin laceration repair, buccal mucosa, split lip, local anesthesia, facial anesthesia

OVERVIEW

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Lacerations of the lower lip and of facial soft tissue in the lower chin require proper anesthesia to ensure adequate cosmetic closure. The mental nerve block is a simple technique to supply anesthesia to this area. A mental nerve block does not anesthetize any teeth on the mandible.


INDICATIONS

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  • Lacerations to the lower lip


  • Lacerations to the soft tissue of the chin that extend from the lip anteriorly to the alveolar process (see side view) and caudally to the mid body of the mandible (see front view)


Region of anesthesia (side view).


Region of anesthesia (front view).


CONTRAINDICATIONS

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  • Uncooperative patient


  • Infected tissue


ANESTHESIA

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  • Some local anesthetic agents are typically used for dental procedures.

    • Lidocaine 1% with epinephrine 1:100,000


    • Mepivacaine 3% (Carbocaine)


    • Bupivacaine 0.5% (Marcaine, Sensorcaine)
       
  • Topical anesthetic agents are often useful prior to local anesthetic administration but are not required.

    • Viscous lidocaine (Xylocaine)


    • Tetracaine (Pontocaine)


EQUIPMENT

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  • Local anesthetic agent of choice 


  • Needle, 25-27 gauge


  • Syringe, 5 mL


  • Topical anesthetic


  • Gauze


  • Proper lighting


POSITIONING

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Place the patient in a semi-recumbent position on the gurney. Another option is to position the patient in a dental or ENT chair, if available.


TECHNIQUE

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  • Apply topical anesthesia as needed.


  • Draw 2-5 mL of local anesthetic into the syringe.


  • Locate the mental foramen.

    • Retract the cheek laterally.


    • The mental foramen is palpable between the 2 lower premolar teeth in adults and between the first and second primary molars in children.
       
  • Insert the needle along the lower gum line into the buccal fold between the premolar teeth (in adults) near the foramen. Do not place the needle directly into the foramen.



  • Mental nerve block injection site.


  • Aspirate.


  • Inject 2-3 mL of anesthetic. Do not inject directly into the foramen.


PEARLS

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  • The mental nerve block provides anesthesia only to the lower lip and soft tissue of the chin. It does not provide anesthesia to the teeth.


  • If the foramen is not directly palpable, the anesthetic can be injected into the buccal mucosa between the 2 lower premolar teeth. Never inject into the foramen, as this can permanently damage the neurovascular bundle.


  • A dental aspirating syringe with a dental carpule can be used in place of a regular syringe. Slide the carpule into the syringe and place the needle on the end.


COMPLICATIONS

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  • Bleeding


  • Infection


  • Needle breakage


  • Intravascular injection


  • Neurapraxia (secondary to direct injection into the mental foramen)


FOR MORE INFORMATION

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American Dental Association
211 E Chicago Ave
Chicago IL 60611-2678
312-440-2500

American Society of Plastic Surgeons
444 E Algonquin Rd
Arlington Heights IL  60005
888-4-PLASTIC


FURTHER READING

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eMedicine.com, Inc: Local Anesthetic Agents, Infiltrative Administration

eMedicine.com, Inc: Local Anesthesia and Regional Nerve Block Anesthesia


MULTIMEDIA

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Media file 1:  Mental nerve block injection site.
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Media type:  Image

Media file 2:  Region of anesthesia (side view).
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Media type:  Image

Media file 3:  Region of anesthesia (front view).
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Media type:  Image


REFERENCES

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  • Amsterdam JT. Mental Nerve Block. In: Rosen P, Chan T, Vilke G, Sternbach G. Atlas of Emergency Procedures. St. Louis, Missouri: Mosby; 2001:166-167.
  • Amsterdam JT. Regional Anesthesia of the Head and Neck. In: Roberts JR, Hedges JR. Clinical Procedures in Emergency Medicine. 3rd ed. Philadelphia: WB Saunders; 1998:33:507.

Mental Nerve Block excerpt

Article Last Updated: Jan 13, 2006
Topic originally published: Jan 5, 2006