Cervical plexus innervation of mandibular molars

The article entitled ‘Effective Pain Management Strategies in Endodontic Therapy’ in the July/August 2016 issue of Dental Update was a great read.¹ Interestingly, various strategies can be applied in clinical practice for effective pre- and post-operative pain management in patients requiring endodontic treatment. With regards to the effectiveness of anaesthesia in mandibular molars diagnosed with irreversible pulpitis, inferior alveolar nerve block (IANB) is ineffective in many instances. In these cases, supplementary techniques like intra-ligamentary injection, intraosseous injection, intra-pulpal injection are undeniably helpful, as mentioned by the author.¹ However, I would like to highlight the role of cervical plexus in the innervation of mandibular molars. Branches from the cervical plexus have been found to innervate the posterior part of the mandible via the transverse cervical nerve.^2,3 These findings possibly explain the reason for failure of inferior alveolar nerve block in many patients. Furthermore, in another study,⁴ supplementary injection with intra-oral cervical plexus anaesthetic technique proved to be effective in as many as 60% of the patient. These patients had mandibular molars diagnosed with irreversible pulpitis, and IANB failed to anaesthetize the offending teeth. Hence, the use of a supplementary injection to anaesthetize the branches from the cervical plexus can prove to be useful in cases where conventional IANB fails.