Dentaltown April 2018 - 98

The cervical plexus nerve
and anesthetic technique
The description below pertains to the cervical plexus
nerve and anesthetic technique as part of the AIAP.
The cervical plexus arises from the spinal cord by
two roots-a dorsal root that supplies sensory fibers,
and a ventral root that supplies motor fibers. These roots
unite within the intervertebral space and exit the spinal
column as a single nerve through the intervertebral
foramina. The anterior divisions of the second, third
and fourth cervical nerves travel toward the lateral
surface of the sternocleidomastoid muscle, where they
intermingle to form the CP, which has muscular and
cutaneous branches.
The CP cutaneous branches comprise the supraclavicular (C3-C4), the lesser occipital (C2), the great
auricular nerve (C2-C3) and the transverse cervical
nerve, or TCN (C2-C3), which innervates the anterior
region of the neck and mandible. For administration
of the intraoral cervical plexus anesthetic technique for
the GAN and TCN, the patient should keep the mouth
closed, or only slightly open, to allow the dentist to relax
the soft tissues, cheek and the masseter muscle, which
permits the syringe to reach the area to be anesthetized.
A syringe with a 30-gauge short needle is placed through
the vestibular area of the buccal mucosa below the
roots of the mandibular molar, using an inclination of
45 degrees in an anterior-posterior direction (Fig. 1).
The tip of the needle is inserted below the roots of the
tooth to be anesthetized, and should be in direct contact
with the bone (Fig. 2).
An aspiration must be performed before placement
of the anesthetic solution, which should be administered
slowly to minimize pain while feeling no resistance along
the external oblique line of the body of the mandible.
Before administering the injection, it's recommended
to palpate along the border of the mandible for the
transverse facial artery. In addition, the finger should be
maintained externally to follow the path of the needle
to ensure that it has reached the desired position.5
Posterior mandible anesthetic failure is a major
public health issue, and the AIAP will help alleviate
the patient's fear to the dental chair while improving
our profession's reputation. After getting profound
pulpal anesthesia on the posterior mandible with the
AIAP, confidently you would be able to say more often,
"Hello, dental pulp!" ■

Fig. 1: Cervical plexus intraoral technique needle
insertion and angulation (second molar).

Fig. 2: Intraoral cervical plexus anesthetic
technique, lateral view (first molar).

References
1.

2.
3.
4.
5.

6.
7.
8.
9.

10.
11.

12.

Endodontics: Colleagues for Excellence. Important Clinical Factors Related to
Local Anesthesia. American Association of Endodontists. Bonus Material A.
Winter, 2009.
Malamed S. Handbook of Local Anesthesia. 6th ed. St Louis, MO: Mosby;
2013. p.387.
Uzbelger Feldman, D. The Cervical Plexus: An Evolution Shift in the Accessory
Innervation Theory. Eur Endod J 2017; 2(1): 17-17.
Resnik, CM. Pressure or Pain in the Dental Chair? Journal of Anesthesia
History 2 (2016) 69-70.
Bitner D, Uzbelger Feldman D, Axx K, Albandar AM. Description and
evaluation of an intraoral cervical plexus anesthetic technique. Clin Anat 2015;
28(5):608-13.
Nusstein JM, Reader A, Drum M. 2010. Local anesthesia strategies for the
patient with a " hot" tooth. Dent Clin North Am 54:237-247.
Malamed SF. 2011. Is the mandibular nerve block passe?. JADA 142:3S-7S.
Gow-Gates GA, Watson JE. The Gow-Gates mandibular block: further understanding. Anesth Prog. 1977 Nov-Dec;24(6):183-189.
Uzbelger-Feldman D, Bitner D, Axx KT, Chattopadhyay A. 2007. Effectiveness
of supplemental cervical plexus anesthetic technique for achieving anesthesia in
mandibular molars with irreversible pulpitis. J Endod 33:345.
Lin K, Uzbelger Feldman D, Barbe MF. Transverse cervical nerve: implications
for dental anesthesia. Clin Anat 2013; 26(6):688-92.
Ella B, Langbour N, Caix P, Midy D, Deliac P, Burbaud P. Transverse cervical
and great auricular nerve distribution in the mandibular area: A study in
human cadavers. Clin Anat 2014; 28(1):109-117.
Kim S, Uzbelger Feldman D, Yang J. A Systematic Review of the Cervical
Plexus Accessory Innervation and Its Role in Dental Anesthesia. Journal of
Anesthesia History 2016; 2(3):79-84.

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Table of Contents for the Digital Edition of Dentaltown April 2018

Dentaltown April 2018 - Intro
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