Mandibular nerve block (Gow gates technique)

Gow Gates Nerve Block Technique is one of the alternative techniques that is used to anesthetize the mandibular branch of trigeminal nerve, Gow Gates Technique is used particularly when the patient can open his/her mouth wide enough and there is history of failure of inferior alveolar nerve block due to anatomical variations or any other problem.

Nerves to be anesthetized

  • Inferior Alveolar Nerve
  • Mental Nerve
  • Incisive Nerve
  • Lingual Nerve
  • Mylohyoid Nerve
  • Auriculotemporal Nerve
  • Buccal Nerve (In 75% of the patients)

Steps for giving Gow-Gates Nerve Block Technique

  • The patient should be fully reclined on the dental chair, opening his/her mouth as wide as possible.
  • The patient should open so that the condyle translate fully over the articular eminences so if the patient cannot open wide enough, that technique shouldn't be applied.
  • Place the thumb of non working hand in the mouth retracting the cheek.
  • The thumb should be close to the site of entry point of the needle.
  • Palpate the coronoid notch and slide the finger or thumb to rest over internal oblique ridge.
  • Move thumb superiorly by about 10 mm.
  • Rotate the thumb to be parallel to an imaginary line joining the tragus of the ear and the ipsilateral corner of the mouth.
  • Place the middle finger of the same hand over the inter-tragal notch.
  • So, the non working hand is held in a C position with the thumb inside the mouth retracting the cheek and the middle finger is placed over the inter-tragal notch.
  • Apply topical anesthesia first.
  • Aim the needle tip towards the inter-tragal notch by using long 27 gauge needle.
  • The handle of the syringe should be at the level of lower premolars.
  • Point of entry on buccal mucosa just distal to maxillary second molar at the height of mesiopalatal cusp tip.
  • Your main target is bone touch (The neck of the condlye) so, if the needle doesn't hit the bone, you should withdraw the needle and go laterally or medially.
  • When there is bone touch, withdraw the needle about 1 mm to avoid injecting into the periosteum which is very painful.
  • You should aspirate first before injecting the anesthetic solution, to make sure that you don't injecting in a blood vessel.
  • Inject the anesthetic solution and then withdraw the needle.

The injection should be just anterior to the neck of the condyle in proximity to the mandibular branch of the trigeminal nerve after it exits from the foramen ovale.

Video illustrates Gow-Gates Nerve Block Injection Technique

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