Inferior Alveolar Nerve Block – The Genius Prof
Oral Surgery

Inferior Alveolar Nerve Block

4 min read


Still confused about inferior alveolar nerve block?

There is all what you need to know.


To deposit solution around the inferior alveolar nerve as it enters the mandibular foramen.



  • Ask patient to open mouth widely.
  • Palpate the coronoid notch with your index finger.
  • Move medially to palpate the internal oblique ridge.
  • Identify the pterygomandibular raphe.


  • Insertion point: pterygotemporal depression that is lateral to raphe.
  • To identify insertion point you must first identify :
  • Coronoid notch (greatest concavity on the anterior border of the ramus).
  • Pterygomandibular raphe.
  • Occlusal plane of the mandibular posterior teeth.

PTD: pterygotemporal depression,   PMF: pterygomandibular fold,  CN: coronoid notch,


GOT IT?!                                                                         

  • Dry the tissues and apply topical anesthesia for 1-2 minutes.
  • Retract the cheek by a mirror.
  • With a long needle, Insert form the contra-lateral premolar area 2/3 of the needle until gently touch bone.
  • Deposit 1.5 ml of solution slowly (within 60-90 seconds).
  • If you want to anesthetize the lingual nerve, withdraw the needle until have only 5 mm inside the tissue and deposit 0.3 ml.
  • Withdraw the needle carefully.

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  • Too High injection lead to:
  • Trismus due to injection into lateral pterygoid muscle.
  • Numbness of the ear due to injection near to auriculotemporal nerve.
  • Toxicity due to injection into the pterygoid plexus of veins.
  1. Too low injection leads to:
  • Trismus due to injection into medial pterygoid muscle.
  • Toxicity due to injection into the facial vein.

3   .Too low and deep injection leads to facial paralysis due to injection into the

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Clinical tips & tricks:


  • Don’t deposit local anesthetic if bone is not contacted. The needle tip may be resting within the parotid gland near the facial nerve (cranial nerve VII).
  • Don’t contact bone forcefully otherwise, pain is generated.
  • Don’t ever never insert the needle up to the hub.

[/vc_column_text][vc_column_text]Ifs :

  • If bone is contacted too soon (less than half the length of a long dental needle):

REASON:  the needle tip is usually located too far anteriorly (laterally) on                            the ramus ,

To correct:

  • Withdraw the needle slightly but do not remove it from the tissue.
  • Bring the syringe barrel around toward the front of the mouth, over the canine or lateral incisor on the contralateral side.
  • Redirect the needle until a more appropriate depth of insertion is obtained.

The needle tip is now located posteriorly in the mandibular sulcus.

  • If bone is not contacted,

REASON:  the needle tip is usually located too far posterior (medial).

To correct:

  • Withdraw it slightly in tissue (leaving approximately one fourth its length in tissue) and reposition the syringe barrel more posteriorly (over the mandibular molars).
  • Continue the insertion until contact with bone is made at an appropriate depth (20 to 25 mm).


  • If Over insertion with no contact of bone.

REASON: The needle is usually posterior (medial) to the ramus.

To correct:

  • Withdraw it slightly from the tissues
  • reposition the syringe barrel over the premolars


Accessory innervation:

  • Cross the midline:

Nerves from the left side may cross the midline to enervate the right side and vice versa               Counteracted by : Buccal & Lingual infiltration of the tooth in the other side.

  • Cutaneous coli (C.C):

it is derived from the cervical plexus around C2 & C3 to supply the pulp of lower premolars               Counteracted by : Buccal infiltration.

  • Nerve to mylohyoid:

although it is a motor branch , it may carry some sensory fibers to the pulp of lower   molar             Counteracted by : Lingual infiltration.



  • Infection/inflammation at injection site.
  • In patients at risk for self-injury (e.g. children – mentally handicapped), because they might keep biting either the lip or the tongue; causing hematoma.

Long buccal nerve block:

  • Identify landmarks :
    1. Hard tissue landmark : anterior border of the ramus.
    2. Soft tissue landmark : mucus membrane distal and buccal to the last molar in the arch.
  • Dry then apply topical
  • Needle inserted 2-3 mm, parallel and at the level of the occlusal plane.
  • When touch bone, deposit 0.3 mm of solution.
  • withdraw the needle carefully.

Credits: Dr. Abdalla Jallal[/vc_column_text][stm_post_tags][stm_post_comments][/vc_column][/vc_row][/vc_section]

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