Keetly et al7 while discussing the possible reasons for failure of inferior alveolar nerve block identified by the participants as being unable to locate anatomical landmarks like pterygomandibular raphe, inability to find a bony landmark with the needle, inability to direct the needle satisfactorily due to tough tissue in the pterygomandibular space, large tongue unable to rest passively, difficult anatomy where posterior teeth have been lost and alveolar resorption has been excessive and needle curved due to excessive manipulation within the tissues.
Applied anatomy of the pterygomandibular space: improving the success of inferior alveolar nerve blocks.
Infratemporal space infection can be observed after maxillary molar infections, a posterior superior alveolar nerve or inferior alveolar nerve blocks as well as mandibular third molar infections that spread to pterygomandibular space
(1,3-25) From this search, we found that glomangiopericytomas have also been reported in cardiac muscle, (4,7) the pterygomandibular space
, (6) and the upper and lower limbs.
Complications related to IANB injection include transient facial paralysis, trismus, local anaesthetic injected into blood vessel, self-inflicted trauma, damage to sphenomandibular ligament and pterygomandibular space
Based on this finding, inserting the needle 4 mm above the occlusion level of the molar is enough to go through the pterygomandibular space
without difficulty in order to perform the inferior alveolar nerve block.
The region of the bone between the neck of the mandible and a hori-zontal line in the ramus of mandible just above the mandibular foramen was removed carefully to ex-pose the pterygomandibular space
. After removing the pterygoid venous plexus and lower fibers of the lateral pterygoid muscle, inferior alveolar neurovas-cular bundle was cleaned.
Conventional IANB was performed by depositing anesthetic agent of 2ml of 2% lignocaine hydrochloride (Septodent France) and epinephrine 1: 100,000 using 27-gauge disposable needle in pterygomandibular space
while retrieving needle lingual nerve block, and after withdrawing needle long buccal nerve blocks were also performed in both groups.