Superficial Cervical Plexus Block Combined with Auriculotemporal Nerve Block for Drainage of Dental Abscess in Adults with Difficult Airways

Abstract

We report our use of a superficial cervical plexus block to manage three adults who presented for drainage of dental abscesses. All patients had difficult airways related to severe trismus (preoperative inter-incisor distance ≤1.5 cm). The first two patients, whose abcesses involved both the submandibular and submasseteric spaces, were managed with combined superficial cervical plexus and auriculotemporal nerve block. In a third patient, a superficial cervical plexus block alone was sufficient because the abscess was confined to the submandibular region. The blocks were successful in all three cases with minimal requirement for supplemental analgesia. We recommend the consideration of superficial cervical plexus block, and if necessary an auriculotemporal nerve block, for the management of selected patients with difficult airways who present for drainage of dental abcesses.

Decompression of Ludwig’s angina in a pregnant patient under bilateral superficial cervical plexus block

“…The block, coupled with bilateral mandibular nerve block provided ample anaesthesia to perform a thorough incision and drainage, including transection of mylohyoid with lowering of the floor of mouth and rapid relief of respiratory obstruction. Ling et al also recommended the consideration of superficial cervical plexus block, to manage selected patients with difficult airways who present for drainage of dental abscesses (Ling et al 2009). Moshe et al advocated superficial cervical plexus block with concomitant mandibular nerve block with a high success rate, low complication rate and high patient acceptance rate for the drainage of submandibular and submental abscesses (Shteif et al 2008).…”