Gow-Gates Technique:: Name: Abdullah Muhammad Khaleel Group: D2 Oral Surgery Homework

Name: Abdullah Muhammad Khaleel
Group: D2
Oral Surgery Homework.
Gow-Gates Technique :
Other Common Names. Gow-Gates technique, third division nerve block, V3
nerve block.
Successful anesthesia of the mandibular teeth and soft tissues is more difficult
to achieve than anesthesia of maxillary structures. Primary factors for this
failure rate are the greater anatomic variation in the mandible
and the need for deeper soft tissue penetration. In 1973, George Albert
Edwards Gow-Gates (1910-2001),33
a general practitioner of dentistry in Australia, described a new approach to
mandibular anesthesia. He had used this technique in his practice for
approximately 30 years, with an astonishingly high success rate
(approximately 99% in his experienced hands).
Nerves Anesthetized
1. Inferior alveolar
2. Mental
3. Incisive
4. Lingual
5. Mylohyoid
6. Auriculotemporal
7. Buccal (in 75% of patients)
Areas Anesthetized:
1. Mandibular teeth to the midline
2. Buccal mucoperiosteum and mucous membranes on
the side of injection
3. Anterior two thirds of the tongue and floor of the oral
cavity
4. Lingual soft tissues and periosteum
5. Body of the mandible, inferior portion of the ramus
6. Skin over the zygoma, posterior portion of the cheek,
and temporal regions
1
Area anesthetized by a mandibular nerve block (Gow-Gates).
Indications:
1. Multiple procedures on mandibular teeth
2. When buccal soft tissue anesthesia, from the third molar
to the midline, is necessary
3. When lingual soft tissue anesthesia is necessary
4. When a conventional inferior alveolar nerve block is unsuccessful
Contraindications:
1. Infection or acute inflammation in the area of injection (rare)
2. Patients who might bite their lip or their tongue, such as young children and
physically or mentally
handicapped adults
3. Patients who are unable to open their mouth wide (e.g., trismus)
Advantages:
1. Requires only one injection; a buccal nerve block is usually unnecessary
(accessory innervation has been blocked)
2. High success rate (>95%), with experience
3. Minimum aspiration rate
4. Few postinjection complications (e.g., trismus)
5. Provides successful anesthesia where a bifid inferior alveolar nerve and
bifid mandibular canals are present.
2
Disadvantages:
1. Lingual and lower lip anesthesia is uncomfortable for many patients and is
possibly dangerous for certain
individuals.
2. The time to onset of anesthesia is somewhat longer (5 minutes) than with
an IANB (3 to 5 minutes), primarily because of the size of the nerve trunk
being anesthetized and the distance of the nerve trunk from
the deposition site (approximately 5 to 10 mm).
3. There is a learning curve with the Gow-Gates technique.Clinical experience
is necessary to truly learn the
technique and to fully take advantage of its greater success rate. This learning
curve may prove frustrating
for some persons.
Positive Aspiration. 2%.
Target area for a Gow-Gates mandibular nerve block—neck of

the condyle.
3
Technique:
1. 25- or 27-gauge long needle recommended
2. Area of insertion: Mucous membrane on the mesial of the mandibular
ramus, on a line from the intertragic
notch to the corner of the mouth, just distal to the maxillary second molar
3. Target area: Lateral side of the condylar neck, just below the insertion of
the lateral pterygoid muscle
4. Landmarks
a. Extraoral
(1) Lower border of the tragus (intertragic notch).
The correct landmark is the center of the external auditory meatus, which is
concealed by
the tragus; therefore its lower border is adopted as a visual aid.
(2) Corner of the mouth
b. Intraoral
(1) Height of injection established by placement of
the needle tip just below the mesiolingual (mesiopalatal) cusp of the maxillary
second molar.
(2) Penetration of soft tissues just distal to the maxillary second molar at the
height established in the preceding step.
5. Orientation of the bevel: Not critical
6. Procedure
The thumb feels along the attachment of the temporal muscles to the coronoid
process. Medial to this, the needle is inserted into the mucosa at the height of
the occlusal plane of the M2sup. The index finger of the same hand is placed in
the external auditory canal and the needle is then inserted about 25–27 mm in
the direction of the index finger. Bone contact is made with the medioventral
side of the condyle.
It is necessary to aspirate because the needle point may enter the maxillary
artery. After aspiration, an entire cartridge of anaesthetic fluid is injected.
After 2–3 minutes the following branches of the mandibular nerve will be
anaesthetised: the inferior alveolar nerve, the lingual nerve and almost always
the buccal nerve. If the needle is introduced too far, the mandibular caput may
be missed and the needle will shift over the mandibular incisura into the
masseteric muscle.
4
Drawing (A) and photo of patient (B) show the
Gow-Gates technique foranaesthesia of the mandibular nerve. On the lingual
side of the coronoid process, at the height of the M2sup the needle is
inserted in the mucosa in the direction of the external auditory canal. The
needle is introduced almost completely until bone contact is made
with the medioventral side of the condyle.

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Target area for a Gow-Gates mandibular nerve block—neck of

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