**7. Modified Jorgensen & Hayden technique**

Patient positioning and maintenance of aseptic conditions are prerequisites to avoid compli‐ cations with local anesthesia. The technique is performed with a long needle gauge (25 mm). We use the index finger to palpate the point of greatest depression of the Coronoid fossa/notch. This will give us a notion of the height of the puncture. We then move the index finger posteriorly, maintaining the cheek and the deep temporal muscle tendon retraction while feeling the temporal crest (Figure 7).

**Figure 7.** Palpation on the coronoid fossa, delimitating the area of puncture.

This modification is proposed to ensure better delimitation and also narrow the area of puncture, facilitating IAN block. We maintain this position during the technique. The needle is inserted medially to the temporal crest, and laterally to the pterygomandibular raphe. The height of the puncture is center of the fingernail, which corresponds to the center of the Coronoid fossa/notch (Figure 8).

**Figure 8.** Palpation on the temporal crest.

a point immediately above the mandibular foramen. According to the literature, a needle inserted 5 mm above the occlusal plane and parallel to it would lie above the lingula in 64% of mandibles and below it in 36%. A needle placed 11 mm above the occlusal plane would be

**Contralateral premolars:** The premolars on the opposite side of injection are used to help direct

Patient positioning and maintenance of aseptic conditions are prerequisites to avoid compli‐ cations with local anesthesia. The technique is performed with a long needle gauge (25 mm).

above the lingula in 96% of mandibles. [20]

50 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

**Figure 6.** Position of the syringe in relation to the opposite premolar teeth.

**7. Modified Jorgensen & Hayden technique**

the syringe (Figure 6).

**Figure 5.** Mandibular lingula position.

The syringe is positioned parallel to the occlusal plane and directed between the premolars of the opposite side. The needle is inserted until hitting the bone (Figure 9).

**Figure 9.** Needle insertion until hitting the bone.

This area is immediately over the mandibular lingula and near the mandibular foramen. The next step is to pull back 1mm to avoid intravascular injection. Then we aspirate and slowly inject almost all of the anesthetic solution. We then withdraw the needle halfway and inject the remainder of the anesthetic solution to block the lingual nerve. The buccal nerve must be anesthetized separately.
