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<b>Background</b> <p>Inferior alveolar nerve block (IANB) is routinely performed to achieve mandibular anesthesia; however, its efficacy is frequently hindered by anatomical variability, dense cortical bone, and difficulty in accurately identifying the mandibular foramen. These factors contribute to inconsistent outcomes and technique sensitivity.</p> <b>Objective</b> <p>To introduce and clinically evaluate an intraoral IANB technique guided by extraoral anatomical landmarks aimed at improving precision and reliability.</p> <b>Methods</b> <p>The technique is based on three palpable extraoral landmarks: the anterior border of the ramus, posterior border of the ramus, and a reference point formed by the intersection of two imaginary lines. This point is used to guide intraoral needle placement with the assistance of the operator’s index finger, enabling accurate direction toward the lingula. The method was applied in 102 patients using a 27-gauge long needle with administration of 1.8 mL of 2% lignocaine containing 1:80,000 adrenaline. Success was assessed through patient-reported comfort and the presence of objective clinical signs, including onset of lower lip numbness. Patients were observed for procedure-related complications.</p> <b>Results</b> <p>Consistent and effective mandibular anesthesia was achieved in all cases. The technique demonstrated reliable localization with no recorded complications such as hematoma, aspiration, facial nerve involvement, trismus, or postoperative paresthesia.</p> <b>Conclusion</b> <p>This extraoral landmark-guided intraoral approach offers a simple, reproducible, and clinically dependable method for IANB, enhancing accuracy while maintaining safety.</p>

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An Intraoral Inferior Alveolar Nerve Block Technique Guided by Extraoral Anatomical Landmarks

  • 期刊论文

  • 发表日期：

    2026年4月27日

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  • Dishantkumar Sonpal,
  • Khalid Mohammed Agwani,
  • Ramank Mathur

摘要

Background

Inferior alveolar nerve block (IANB) is routinely performed to achieve mandibular anesthesia; however, its efficacy is frequently hindered by anatomical variability, dense cortical bone, and difficulty in accurately identifying the mandibular foramen. These factors contribute to inconsistent outcomes and technique sensitivity.

Objective

To introduce and clinically evaluate an intraoral IANB technique guided by extraoral anatomical landmarks aimed at improving precision and reliability.

Methods

The technique is based on three palpable extraoral landmarks: the anterior border of the ramus, posterior border of the ramus, and a reference point formed by the intersection of two imaginary lines. This point is used to guide intraoral needle placement with the assistance of the operator’s index finger, enabling accurate direction toward the lingula. The method was applied in 102 patients using a 27-gauge long needle with administration of 1.8 mL of 2% lignocaine containing 1:80,000 adrenaline. Success was assessed through patient-reported comfort and the presence of objective clinical signs, including onset of lower lip numbness. Patients were observed for procedure-related complications.

Results

Consistent and effective mandibular anesthesia was achieved in all cases. The technique demonstrated reliable localization with no recorded complications such as hematoma, aspiration, facial nerve involvement, trismus, or postoperative paresthesia.

Conclusion

This extraoral landmark-guided intraoral approach offers a simple, reproducible, and clinically dependable method for IANB, enhancing accuracy while maintaining safety.