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Fluoroscopically guided mandibular nerve block: a modified lateral approach
  1. Jeffrey Jon Mojica,
  2. Vinay Kudur,
  3. Rudy Garza III and
  4. Maxim S Eckmann
  1. Anesthesiology, University of Texas Health Science Center, San Antonio, Texas, USA
  1. Correspondence to Dr Jeffrey Jon Mojica, Anesthesiology, University of Texas Health Science Center, San Antonio TX 78229, USA; jeffrey.mojica{at}


Background and objectives Mandibular nerve blocks are indicated for atypical face pain and trigeminal neuralgia. We hypothesized that a modified lateral approach, which entailed a combination of lateral and anterior approach techniques to the mandibular nerve block would lead to similar efficacy and improved safety profile rather than the typical lateral or anterior techniques.

Methods This alternative approach was derived from anatomical investigation using the Radiology Anatomy Atlas Viewer and reconstructed axial cadaveric slices. We used axial slices at the level of the lateral pterygoid plate, and at the level of the temporomandibular joint to devise a needle path appropriate for this block.

Results The modified lateral approach to the mandibular nerve block was verified theoretically through cadaveric reconstructed slices and has been successfully performed in our practice. Precise needle trajectory could avoid both periosteal contact and gross redirection, as well as other procedural complications.

Conclusion The modified lateral approach to a mandibular nerve block avoids the respective risks associated with either the lateral and anterior approach. Facial intervention techniques typically pose increased safety challenges, however through cadaveric anatomic reconstruction, we have developed a safer approach for mandibular nerve blockade.

  • chronic pain
  • facial pain
  • pain management
  • diagnostic techniques and procedures

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  • Contributors JJM: primary writer, proceduralist. MSE: concept development and execution. RG: editing and images. VK: writer and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.