MAUI, HAWAII An upper and lower lip mucosal block provides fast, easy, and effective regional anesthesia for lip procedures, Dr. Howard K. Steinman said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.
"Learn this mucosal block," he urged. "It has revolutionized my practice more than any other simple technique I have learned in the last 5 years."
"When patients come to your office, they're secretly praying that what you're going to do is going to be painless," said Dr. Steinman of the University of California, San Diego.
"When you get patients ready for what they expect to be a happy, painless, rejuvenating experience, and they're unhappy," he explained, "everyone in the room is unhappy." Using the mucosal block greatly improves the satisfaction of patients.
Equipment required for the mucosal block procedure is simple and modestly priced.
"You don't need a multithousand-dollar energy device," Dr. Steinman said.
The supplies needed include topical anesthetic (such as Hurricaine gel), dental needles, lidocaine Carpules, and a Carpule syringe. Dental syringes, which can be purchased from dental supply companies, are "incredibly" inexpensive, he noted.
The anesthesia requires nothing that is not already in the office, including anesthetic gel and "lots and lots of Q tips," he said.
If there's going to be a lot of dental gel in a patient's mouth during a cosmetic procedure, be sure to have some bottled water available, because many people really don't like the gel's taste.
Injected anesthetics that can be used to perform the mucosal block include lidocaine, bupivacaine, mepivacaine, and others.
Dr. Steinman outlined the procedure for performing the upper- and lower-lip mucosal block. "What you're blocking is the infraorbital nerve," he explained.
The first step in the procedure is to apply topical anesthetic. Then, at the gingival-buccal sulcus, just lateral to the apex of the canine tooth, inject a small amount of anesthetic approximately 0.5 cm upward along the maxilla. The next step is to inject from this point mediallyin the potential space between the mucosa and the periosteumalong the sulcus to the frenulum.
The procedure should be repeated on the contralateral side. Inject a small amount from the sulcus next to the frenulum toward the anterior nasal spine, he added.
For the patient's lower lip, inject submucosally in the sulcus from the point below the oral commissure to the contralateral side.
Finally, because the nerve block does not reach the corners of the mouth, it is necessary to apply topical anesthetic on the mucosal surface of the oral commissures and then inject a small amount of anesthetic to anesthetize the corners of the mouth. Injecting these areas takes a total of about 15 seconds, Dr. Steinman noted.
It is also important to keep in mind that facial blocks do not impart any vasoconstriction, so consider injecting locally for procedures that result in bleeding, he added.
Dr. Steinman emphasized that the mucosal block works fast.
"This block will numb up someone's lip in approximately 1015 seconds," he said. "As a matter of fact, when I'm doing it, the side I've numbed up will largely be numb by the time I get to the other side of the lip.
"So it's very effective for lip procedures, very effective for fillers especially," he said. "As we say in Southern California," he concluded, "this block rocks."
Dr. Steinman said that he had no relevant conflicts of interest.
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Your patients are secretly praying that what you're going to do is going to be painless. DR. STEINMAN