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 Area anesthetized by a mandibular nerve block (Gow-Gates).
a general practitioner of dentistry in Australia, described a new approach to
mandibular anesthesia. He had used this technique in his practice for Indications:
approximately 30 years, with an astonishingly high success rate 1. Multiple procedures on mandibular teeth
(approximately 99% in his experienced hands). 2. When buccal soft tissue anesthesia, from the third molar
Nerves Anesthetized to the midline, is necessary
1. Inferior alveolar 3. When lingual soft tissue anesthesia is necessary
2. Mental 4. When a conventional inferior alveolar nerve block is unsuccessful
3. Incisive Contraindications:
4. Lingual 1. Infection or acute inflammation in the area of injection (rare)
5. Mylohyoid 2. Patients who might bite their lip or their tongue, such as young children and
6. Auriculotemporal physically or mentally
7. Buccal (in 75% of patients) handicapped adults
Areas Anesthetized: 3. Patients who are unable to open their mouth wide (e.g., trismus)
Advantages:
1. Mandibular teeth to the midline 1. Requires only one injection; a buccal nerve block is usually unnecessary
2. Buccal mucoperiosteum and mucous membranes on (accessory innervation has been blocked)
the side of injection
3. Anterior two thirds of the tongue and floor of the oral 2. High success rate (>95%), with experience
cavity 3. Minimum aspiration rate
4. Lingual soft tissues and periosteum 4. Few postinjection complications (e.g., trismus)
5. Body of the mandible, inferior portion of the ramus 5. Provides successful anesthesia where a bifid inferior alveolar nerve and
6. Skin over the zygoma, posterior portion of the cheek, bifid mandibular canals are present.
and temporal regions

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Disadvantages:
1. Lingual and lower lip anesthesia is uncomfortable for many patients and is Technique:
possibly dangerous for certain 1. 25- or 27-gauge long needle recommended
individuals. 2. Area of insertion: Mucous membrane on the mesial of the mandibular
2. The time to onset of anesthesia is somewhat longer (5 minutes) than with ramus, on a line from the intertragic
an IANB (3 to 5 minutes), primarily because of the size of the nerve trunk notch to the corner of the mouth, just distal to the maxillary second molar
being anesthetized and the distance of the nerve trunk from 3. Target area: Lateral side of the condylar neck, just below the insertion of
the deposition site (approximately 5 to 10 mm). the lateral pterygoid muscle
3. There is a learning curve with the Gow-Gates technique.Clinical experience 4. Landmarks
is necessary to truly learn the a. Extraoral
technique and to fully take advantage of its greater success rate. This learning (1) Lower border of the tragus (intertragic notch).
curve may prove frustrating The correct landmark is the center of the external auditory meatus, which is
for some persons. concealed by
the tragus; therefore its lower border is adopted as a visual aid.
Positive Aspiration. 2%.
(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.
Target area for a Gow-Gates mandibular nerve block—neck of It is necessary to aspirate because the needle point may enter the maxillary
the condyle. 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.

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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.