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For facial wounds located in the lower lip, inferior to the lower lip, and chin area a mental nerve block is appropriate for anesthesia.
The mental nerve exits the mental foramen within the mandible. It is located in line with the infraorbital and supraorbital foramen. We prefer using the intraoral approach for this nerve block.
Palpate the mental foramen, using a 25 or 27 gauge needle, insert the needle just medial to the mental foramen, directed toward the foramen at the inferior gum line. If the patient experiences any paresthesia withdraw the needle until the symptoms resolve. Inject 2mL of anesthetic into this location. With wounds that are near the midline, a bilateral block will need to be performed to achieve sufficient anesthesia.
Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.
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