J Korean Assoc Oral Maxillofac Surg.  2020 Dec;46(6):403-408. 10.5125/jkaoms.2020.46.6.403.

Single-insertion technique for anesthetizing the inferior alveolar nerve, lingual nerve, and long buccal nerve for extraction of mandibular first and second molars: a prospective study

• Joseph B
• Kumar N
• Vyloppilli S
• Sayd S
• Manojkumar K
• Vijaykumar D

• KMID: 2510012
• DOI: http://doi.org/10.5125/jkaoms.2020.46.6.403

Abstract

Objectives
Appropriate and accurate local anesthetic (LA) techniques are indispensable in the field of oral and maxillofacial surgery to obtain a satisfactory outcome for both the operating surgeon and the patient. When used alone, the inferior alveolar nerve block (IANB) technique requires supplemental injections like long buccal nerve block for extraction of mandibular molars leading to multiple traumatic experiences for the patient. The aim of this study was to anesthetize the inferior alveolar, lingual, and long buccal nerves with single-needle penetration requiring a minimal skillset such as administering a conventional IANB through introduction of the Benny Joseph technique for extraction of mandibular molars.
Materials and Methods
This was a prospective study conducted in the Department of Oral and Maxillofacial Surgery, Kunhitharuvai Memorial Charitable Trust (KMCT) Dental College, Calicut, India. The duration of the study was 6 months, from June to November 2017, with a maximum sample size of 616 cases. The LA solution was 2% lignocaine with 1:100,000 adrenaline. The patients were selected from a population in the range of 20 to 40 years of age who reported to the outpatient department for routine dental extraction of normally positioned mandibular right or left first or second molars.
Results
Of the 616 patients, 42 patients (6.8%) required re-anesthetization, a success rate of 93.2%. There were no complications such as hematoma formation, trismus, positive aspiration, and nerve injuries. None of the cases required re-anesthetization in the perioperative period.
Conclusion
The Benny Joseph technique can be employed and is effective compared with conventional IANB techniques by reducing trauma to the patient and also requires less technique sensitivity.

Keyword

Benny Joseph technique; Lingual nerve block; Inferior alveolar nerve block; Long buccal nerve block

Figure

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  Fig. 1 Identification of the landmarks and points of needle insertion. (PTD: pterygotemporal depression, CN: coronoid notch)

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  Fig. 2 Needle insertion at the deepest point of the pterygotemporal depression.

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  Fig. 3 Retraction of buccal soft tissues and ipsilateral placement of the needle during the initial steps of injection.

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  Fig. 4 Contralateral placement of the syringe for administration of inferior alveolar nerve block after crossing the internal oblique ridge.

Reference

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