Nerve block: Lingual

Overview
Distribution of lingual nerve.
Lingual nerve anatomy branching off V3 mandibular division of the trigeminal nerve.
Intra oral anatomy of lingual nerve.
Lingual anatomy.
  • The lingual nerve is a branch of the mandibular (V3) division of the trigeminal nerve
  • Provides sensation to the anterior two-thirds of the tongue, the floor of the mouth, and the lingual mucous membrane
  • Lingual nerve block is an effective means of anesthesia for tongue lacerations and avoids the anesthesia of the lip, chin, and teeth that inferior alveolar nerve block causes[1]
  • No chance of accidental carotid artery puncture compared to IANB
    • Studies have shown lower rates of nerve injury and trismus compared to IANB as well as greater success rates[2]

Indications
  • Tongue laceration
  • Sublingual abscess drainage
  • Foreign body removal
  • Sialolith removal
  • Periodontal surgery
  • Glossodynia

Contraindications
  • Lingual soft tissue infection
  • Local anesthetic allergy

Equipment Needed
  • Gloves
  • Aseptic mouth rinse
  • 4x4 gauze
  • Suction
  • Syringe
  • 25-27 gauge needle
  • Topical anesthetic
  • Local anesthetic

Procedure[3]
  1. Have the patient rinse their mouth with an aseptic mouth rinse.
  2. Apply soaked gauze with topical anesthetic.
  3. Place patient reclining or upright and have them open their mouth.
  4. Identify site of injection: 1 cm medial to the second mandibular molar.
  5. Have the patient move their tongue to the side or use a tongue blade.
  6. From the contralateral side, approach with your needle and insert 1 cm posteriorly directed.
  7. Aspirate to confirm location is not intravascular.
  8. Inject 1.0 - 1.5 ml local anesthetic.

Complications
  • Hematoma
  • Infection
  • Failure to anesthetize

See Also

References
  1. Balasubramanian S et al. Efficacy of Exclusive Lingual Nerve Block versus Conventional Inferior Alveolar Nerve Block in Achieving Lingual Soft-tissue Anesthesia. Ann Maxillofac Surg. 2017; 7(2): 250-255.
  2. Balasubramanian S et al. Efficacy of Exclusive Lingual Nerve Block versus Conventional Inferior Alveolar Nerve Block in Achieving Lingual Soft-tissue Anesthesia. Ann Maxillofac Surg. 2017; 7(2): 250-255.
  3. Reichman EF. Dental Anesthesia and Analgesia. In: Reichman EF. Emergency Medicine Procedures. 2nd ed. McGraw-Hill; 2013.
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