mandibular nerve blocks
TRANSCRIPT
No external funding and no com-
peting interests declared.
References1. Karagama YG, Lancaster JL, Karkanevatos
A. Nasogastric tube insertion using flex-ible fibreoptic nasendoscope. HospitalMedicine 2001; 62: 336–7.
2. Moore A, Bokhari W. Nasogastric tubeplacement in the structurally abnormalpharynx and oesophagus using a nasen-doscope. Clinical Otolaryngology 2011;36: 295–6.
3. Der Kureghian J, Kumar S, Jani P. Naso-gastric tube insertion in difficult caseswith the aid of a flexible nasendoscope.Journal of Laryngology and Otology2011; 125: 962–4.
doi: 10.1111/j.1365-2044.2012.07096.x
Mandibular nerve blocks
We read with interest the correspon-
dence by Kumar et al. on mandibular
nerve blockade [1]. They reported
the use of peripheral nerve stimula-
tion in an awake patient to improve
the accuracy of local anaesthetic
infiltration using an extra-oral
approach.
Extra-oral techniques such as
that described have previously been
used in the treatment of trigeminal
neuralgia but have largely been
abandoned due to potential compli-
cations [2].
Intra-oral techniques are safe
and effective [3], and can easily be
performed after induction of general
anaesthesia. In cases where there is a
specific desire to provide anaesthesia
of the temporomandibular joint, the
Gow-Gates block allows safe and
effective anaesthesia of the entire
mandibular nerve, including the au-
riculotemporal branch, in a single
intra-oral injection [4]. Where tem-
poromandibular joint ankylosis pre-
vents adequate mouth opening, the
Akinosi-Vazirani technique can be
used [3].
We would encourage readers
considering using novel techniques
such as that described to familiarise
themselves with the various safe,
reliable and proven intra-oral alter-
natives such as the above two
blocks.
A. ScottI. VarleyLeeds General InfirmaryLeeds, UKEmail: [email protected]
No external funding and no com-
peting interests declared. Previously
posted at the Anaesthesia Correspon-
dence website: http://www.anaesthesia
correspondence.com.
References1. Kumar N, Shashni S, Singh R, Jain A.
Mandibular nerve block for peri-operativepain relief using a peripheral nerve stim-ulator. Anaesthesia 2012; 67: 77–8.
2. Stajcic Z, Todorovicz LJ. Blocks of theforamen rotundum and the oval foramen:reappraisal of extra-oral mandibularnerve injections. British Journal of Oraland Maxillofacial Surgery 1997; 35: 328–33.
3. Haas DA. Alternative mandibular nerveblock techniques: A review of the Gow-Gates and Akinosi-Vazirani closed-mouthmandibular nerve block techniques. Jour-nal of the American Dental Association2011; 142: 8–12S.
4. Zandi M, Seyedzadeh Sabounchi S.Design and development of a device forfacilitation of Gow-Gates mandibularblock and evaluation of its efficacy. Oraland Maxillofacial Surgery 2008; 12:149–53.
doi: 10.1111/j.1365-2044.2012.07125.x
Internal diameter markingon tracheal tube connectors
We write to comment on the clinical
‘snippet’ submitted by Drs Sinha and
(a) (b) (c)
Figure 2 Placement of a gastric tube using a flexible intubating fibrescope: a) remove the 15-mm connector. Slitthe tracheal tube longitudinally along its entire length; lubricate and load onto a flexible intubating fibrescope; b) suctionthe pharynx and then guide the distal tip of the fibrescope into oesophagus. Railroad the split tracheal tube overthe fibrescope approximately 4 cm into the oesophagus; c) remove the fibrescope and pass the lubricated gastrictube via the split tracheal tube into the oesophagus and stomach. Remove the split tracheal tube carefully toavoid displacing the gastric tube. Confirm access to the stomach by either pH testing of aspirates or x-ray.
546 Anaesthesia ª 2012 The Association of Anaesthetists of Great Britain and Ireland
Anaesthesia 2012, 67, 541–553 Correspondence