Mylohyoid Nerve Injection for Unsuccessful Anesthesia of Posterior Teeth with Successful Inferior Alveolar Nerve Block.


  • Rozh M Hussein Department of Oral and Maxillofacial Surgery, College of Dentistry, Hawler Medical University, Erbil, Iraq.



Inferior alveolar nerve block, mylohyoid nerve variation, lingual mucosal infiltration, pain


Background and objective: variations in mylohyoid could lead to failure of an inferior alveolar nerve blockade. This study aimed to evaluate the impact of mylohyoid nerve variation on the persistence of pain following a successful inferior alveolar nerve block.

Method: This clinical study was performed at the oral and maxillofacial department/college of Dentistry, Hawler Medical University. All patients with pain following a successful inferior alveolar nerve block were enrolled in this study. An additional submucosal injection (infiltration technique) as few drops in the lingual mucosa of the offending tooth is given by the same surgeon

Results: A total of fifty patients were enrolled in this study,30 males and 20 females. age range was (16-56). Among the total only 20 patients (60%females,40% males) experienced pain on the lingual side during the attempt of dental extraction. Following lingual infiltration, all the cases were treated successfully in a pain free environment. Descriptive statistics was used to analyze the data.

Conclusion: Lingual submucosal injection of 1/3 of 1.8 ml of local anesthesia might be an effective way to block all possible nerve variation on the lingual side.


-Sandya Kini, Krishnaraj Somayaji, Shashirashmi Acharya, Shivakumar Sampath. Anomalies and Clinical Significance of Mylohyoid Nerve:A Review. Clinical, Cosmetic and Investigational Dentistry journal. 2022; 429-436.

-Behnia H, Kheradvar A, Shahrokhi M. An anatomic study of the lingual nerve. J Oral Maxillofac Surg. 200058;649–651. https://doi. org/10.1053/jo.6209.

-Iwanaga J, Kikuta S, Oskouian RJ, Tubbs RS. Nerve to mylohyoid branched from the lingual nerve: previously undescribed case. Anat Sci Int. 2019;94(3):266-268. doi:10.1007/s12565-019-00476-4.

-Sinha P, Tamang BK, Sarda RK. Communication between mylohyoid and lingual nerve: an anatomical variation. J Clin Diagn Res.2014;8(4):AD01–AD02. doi:10.7860/JCDR/2014/7560.4223.24

- Jablonski T, Cheng NG, Cheng CM. Unusual origins of the buccal and mylohyoid nerves. Oral Surg Oral Med Oral Pathol .1985;60 (5):487–488. doi:10.1016/0030-4220(85)90235-x.

- Ryu EJ, Kim DH .Anatomical insights of the mylohyoid for clinical procedures in dentistry. Clin Anat. 2021; 34(3):461-469. doi: 10.1002/ca.23675. Epub 2020 Sep 21. PMID: 32893917.

- Ryumon S, Hage D, Ibaragi S, Okui T, Tubbs RS, Iwanaga J .Dual innervation of The submandibular gland by nerve to mylohyoid and chorda tympani. Morphologie. 2020 ; S1286- 0115(20)30114-4. doi: 10.1016/j.morpho.2020.11.004. Epub ahead of print.

- Goldberg S, Reader A, Drum M, Nusstein J, Beck B. Comparison of the anesthetic efficacy of the conventional inferior alveolar, Gow-Gates, and Vazirani-Akinosi techniques. J Endod. 2008;34(11):1306–1311.[PubMed] [Google Scholar]

- Kaufman E, Weinstein P, Milgrom P. Difficulties in achieving local anesthesia. J Am Dent Assoc. 1984;108(2):205–208. [PubMed] [Google Scholar]

- Foster W, Drum M, Reader A, Beck M. Anesthetic efficacy of buccal and lingual infiltration of lidocaine following an inferior alveolar nerve block in mandibular posterior teeth. Anesth Prog. 2007;54(4):163–169. [PMC free article] [PubMed] [Google Scholar]

- Zandi M, Seyedzadeh Sabounchi S. Design and development of a device for facilitation of Gow-Gates mandibular block and evaluation of its efficacy. Oral Maxillofac Surg. 2008;12(3):149–153. [PubMed] [Google Scholar]

-Altug HA, Sencimen M, Varol A, Kocabiyik N, Dogan N, Gulses A. The efficacy of mylohyoid nerve anesthesia in dental implant placement at the edentulous posterior mandibular ridge. J Oral Implantol .2012 Apr;38(2):141-7. [PubMed]

-Forbes WC. Twelve alternatives to the traditional inferior alveolar nerve block. J Mich Dent Assoc. 2005 May;87(5):52-6, 58, 75. [PubMed]

-Wilson S, Johns P, Fuller PM. The inferior alveolar and mylohyoid nerves: an anatomic study and relationship to local anaesthesia of the anterior mandibular teeth. J Am Dent Assoc. 1984;108(3):350–352. doi: 10.14219/jada.archive.1984.0005

- 1.Bennett S, Townsend G. Distribution of the mylohyoid nerve: anatomical variability and clinical implications. Aust Endod J. 2001;27 (3):109–111. doi:10.1111/j.1747-4477. 2001.tb00470. x.

- Hasan Ayberk Altug, DDS, PhD,Metin Sencimen, DDS, PhD Altan Varol, DDS, PhD Necdet Kocabiyik, MD Necdet Dogan, DDS, PhD,Aydın Gulses, DDS, PhD. The Efficacy of Mylohyoid NerveAnesthesia in Dental ImplantPlacementat the Edentulous PosteriorMandibular Ridge. Journal of Oral Implantology.2009;141-147

-Clark S, Reader A, Beck M, Meyers WJ Anesthetic efficacy of the mylohyoid nerve block and combination inferior alveolar nerve block/mylohyoid nerve block. Oral Surg. Oral Med Oral Pathol Oral Radiol Endod .1999; 87(5):557-63.

doi: 10.1016/s1079- 2104(99)70133-2. PMID: 10348512.

- Stanley F. Malamed. Handbook of Local Anesthesia 6th edition. 2013.




How to Cite

Hussein RM. Mylohyoid Nerve Injection for Unsuccessful Anesthesia of Posterior Teeth with Successful Inferior Alveolar Nerve Block. EDJ [Internet]. 2024 Jun. 6 [cited 2024 Jul. 20];7(1):50-3. Available from:



Original Articles