Failed Inferior alveolar nerve Blocks: Incidence, Causes & Management

Abstract

Psychological-fear, anxiety, apprehension;5. Improper technique -this is the most common reason for failure of the conventional inferior alveolar nerve block. We emphasize the three most commonly occurring problems with this technique.Inadequate mouth opening: The target area for this block is the mandibular sulcus, which is at the level of the coronoid notch and above the mandibular foramen.' When the mouth opening is not adequate, the inferior alveolar nerve, which descends from above, is relaxed and away from the medial wall of the ramus. Consequently, it is at a distance from the target area, which leads to inadequate anesthesia. When the mouth opening is adequate, the nerve is flush against the medial wall of the ramus and at the target area.' Hence, the patient reports experiencing almost immediate onset of anesthesia. This is why the block does not work in cases of trismus and the closed-mouth block needs to be administered.