Start practicing

Anesthesia · patient case question

The Gow-Gates technique anaesthetizes which nerves?

Patient case: An Extraction, a Block, and a Drooping Eyelid

Patient: 45-year-old female

Chief Complaint: Extraction of tooth #19.

Background: No medical history of note. No known drug allergies, though she reports her mother 'reacts to penicillin.'

Medications: None

Vital Signs: BP 120/76 mmHg · HR 74 bpm · RR 16 · T 98.4°F

Findings: An inferior alveolar nerve block is administered. Within minutes she is unable to close her right eye and the right corner of her mouth droops. Lip and tongue numbness on that side is profound.

  1. The inferior alveolar and mental nerves alone
  2. Only the inferior alveolar nerve
  3. The maxillary division and its branches
  4. Essentially the entire mandibular division — inferior alveolar, lingual, long buccal, mental, incisive, auriculotemporal and mylohyoid
Show answer and explanation

Correct answer: D. Essentially the entire mandibular division — inferior alveolar, lingual, long buccal, mental, incisive, auriculotemporal and mylohyoid

  • A. The mental nerve is a terminal branch of the IAN, so this option is really describing a partial IAN block.
  • B. The conventional inferior alveolar nerve block reaches the IAN and usually the lingual nerve, but reliably misses the long buccal.
  • C. The maxillary division is anaesthetized by a second-division block via the greater palatine canal or the high tuberosity approach.
  • D. CORRECT. The GOW-GATES is a true MANDIBULAR NERVE block. The solution is deposited high, at the neck of the condyle just below the insertion of the lateral pterygoid, where the branches of V3 have not yet fully diverged. It therefore anaesthetizes essentially the whole division — inferior alveolar, lingual, long buccal, mental, incisive, auriculotemporal and mylohyoid. This is why it succeeds where a conventional block fails, including in the presence of accessory innervation via the mylohyoid nerve.

Note: Landmarks: the intertragic notch and the corner of the mouth extraorally; the mesiolingual cusp of the maxillary second molar intraorally, with the patient's mouth WIDE OPEN so the condyle translates forward. Onset is slower (5–7 minutes or more) because of the larger nerve trunk, but the success rate is higher and positive aspiration rates are lower.

Practice Anesthesia questions Anesthesia study notes

More Anesthesia practice questions