Mandibular Conduction Anesthesia Apprpached at the Anterior Site of the Mandibular Foramen-Radiographic Study of the Spread of the Local Analgesic Solution and Clinical Evaluation-

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The conventional inferior alveolar nerve block (conventional technique) is associated with risks of neural and vascular injury. We studied a method for inferior alveolar nerve block by injecting a local anesthetic solution into the pterygomandibular space anterior to the mandibular foramen (anterior technique), with a purpose to avoid such complications.Insertion angle of the anterior technique, the spread of local anesthetic in the inferior alveolar nerve block by the anterior technique was studied, and anesthesia estimation in the anterior technique was examined.(1) The predicted insertion angle of the anterior technique measured on computed tomographic images was 60.1 * 7.1*, in the region of a direction of the contralateral mandibular first molar, and the insertion depth was approximately 10 mm.(2) 18 volunteers were injected with 1.8 ml of a mixture containing lidocaine and contrast medium by either the conventional or the anterior technique, and the course of spread was traced by fluoroscopy in the sagittal plane, and by computed tomography in the horizontal plane. The rates of spread of the contrast medium in the pterygomandibular space for both techniques were the same. The results indicated that the local anesthetic spread rapidly to the inferior alveolar nerve and produced an anesthetic effect in both techniques.(3) We applied the anterior technique to 100 patients for mandibular molar extraction, and assessed the anesthetic effects according to the estimation of Dobbs and DeVier. A success rate was obtained in 74%.The anterior technique achieved the same anesthetic effect as the conventional technique.According to the results, we recommend the anterior technique as a safer alternative for inferior alveolar nerve block.