Gow gates technique
A VARIATION OF THE INFERIOR ALVEOLAR NERVE BLOCK IT ANESTHETIZES THE FOLLOWING NERVES: ● Inferior alveolar nerve (and its branches, the mental and incisive nerves) ● Mylohyoid nerve ● Lingual nerve ● Long buccal nerve (often) ● Auriculotemporal nerve (often) AREAS ANESTHETIZED: ● All mandibular teeth (inferior alveolar nerve) ● Epithelium of the anterior 2/3rds of the tongue (lingual nerve) ● All lingual gingiva and lingual mucosa (lingual nerve) ● All buccal gingiva and mucosa (long buccal and mental nerves) ● Skin of the lower lip (mental nerve) ● Skin along the temple, anterior to the ear, and posterior part of the cheek (auriculotemporal and buccal nerves) STEPS: ● The mouth is opened as wide as possible ● Insert the needle high into the mucosa at the level of the 2nd maxillary molar just distal to the mesiolingual cusp● Use the intertragic notch as an extraoral landmark to help reach the neck of the mandibular condyle ● Advance the needle in a plane from the corner of the mouth to the intertragic notch from the contralateral premolars (this position varies in accordance with individual flare of the mandible) until it contacts the condylar neck ● Withdraw the needle slightly and perform aspiration to observe whether the needle is in a blood vessel ● After a negative result on aspiration, slowly inject the anesthetic ● Have the patient keep the mouth open for a few minutes after injection, to allow the anesthetic to diffuse around the nerves