Fluoroscopically guided mandibular nerve block: A modified lateral approach

Jeffrey Jon Mojica, Vinay Kudur, Rudy Garza, Maxim S. Eckmann

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Article number101707
JournalRegional Anesthesia and Pain Medicine
StateAccepted/In press - 2020


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

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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