Prolonged Field Care Podcast

PFC Podcast 268: Combat Facial Blocks

Mar 2, 2026
Andrew Yenser, an oral and maxillofacial surgeon and educator in facial trauma and regional anesthesia, explains practical facial nerve and dental block techniques for trauma care. He covers infraorbital and mandibular approaches, lidocaine versus long-acting agents, ring blocks for ears and nose, and the value of cross-training and multimodal pain strategies.
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INSIGHT

Maxilla Acts Like A Sponge For Infiltrations

  • The maxilla is porous so vestibular infiltrations diffuse into teeth and soft tissue widely.
  • John and Andrew compare it to a sponge: small injections in the vestibule yield broad maxillary anesthesia.
ADVICE

Catch The Mandibular Nerve Before It Enters The Canal

  • For mandibular (V3) anesthesia, capture the nerve before it enters the dense mandibular canal; intraoral inferior alveolar/IAN technique is required for profound dental anesthesia.
  • David emphasizes the canal makes lower-jaw infiltrations ineffective for teeth — use nerve block technique.
ADVICE

Follow Landmarks For Reliable Inferior Alveolar Block

  • Use intraoral landmarks for inferior alveolar nerve block: thumb at coronoid notch, bisect thumb ~1 cm above occlusal plane, aim two-thirds back toward the pterygomandibular raphe from contralateral side.
  • David outlines bone-sounding technique and walking the needle to confirm depth before injecting.
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