title: Blockade of the mental nerve for lower lip surgery as a safe alternative to general anesthesia in two very old patients.
abstract: OBJECTIVE
  Regional anesthesia is gaining popularity with anesthesiologists as it offers superb postoperative analgesia. However, as the sole anesthetic technique in high-risk patients in whom general anesthesia is not preferred, some regional anesthetic possibilities may be easily overlooked. By presenting two cases of very old patients with considerable comorbidities, we would like to bring the mental nerve field block under renewed attention as a safe alternative to general anesthesia and to achieve broader application of this simple nerve block.
  
  
  METHODS
  Two very old male patients (84 and 91 years) both presented with an ulcerative lesion at the lower lip for which surgical removal was scheduled. Because of their considerable comorbidities and increased frailty, bilateral blockade of the mental nerve was considered superior to general anesthesia. As an additional advantage for the 84-year-old patient, who had a pneumonectomy in his medical history, the procedure could be safely performed in a beach-chair position to prevent atelectasis and optimize the ventilation/perfusion ratio of the single lung. The mental nerve blockades were performed intraorally in a blind fashion, after eversion of the lip and identifying the lower canine. A 5 mL syringe with a 23-gauge needle attached was passed into the buccal mucosa until it approximated the mental foramen, where 2 mL of lidocaine 2% with adrenaline 1:100.000 was injected. The other side was anesthetized in a similar fashion.
  
  
  RESULTS
  Both patients underwent the surgical procedure uneventfully under a bilateral mental nerve block and were discharged from the hospital on the same day.
  
  
  CONCLUSIONS
  A mental nerve block is an easy-to-perform regional anesthetic technique for lower lip surgery. This technique might be especially advantageous in the very old, frail patient.
authors.affiliation: Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Ferdinand Frederik Som Ling
authors.initials: FF
authors.lastname: Tan
authors.affiliation: Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Sjouke
authors.initials: S
authors.lastname: Schiere
authors.affiliation: Department of Anesthesiology, de Tjongerschans Hospital, Heerenveen, the Netherlands.
authors.forename: Auke C
authors.initials: AC
authors.lastname: Reidinga
authors.affiliation: Department of Surgery, de Tjongerschans Hospital, Heerenveen, the Netherlands.
authors.forename: Fennie
authors.initials: F
authors.lastname: Wit
authors.affiliation: Department of Surgery, de Tjongerschans Hospital, Heerenveen, the Netherlands.
authors.forename: Peter Hjm
authors.initials: PH
authors.lastname: Veldman
keywords: intraoral; mental nerve block; percutaneous; regional anesthesia; ultrasound