Our case report was written and published as a clinical article. Dr. Hutchins’ main criticism of the report appears to concern the course of anesthetic flow to produce the clinical symptoms presented. The symptoms included typical anesthesia to the inferior alveolar nerve, blanching and anesthesia to the infra-orbital area of the maxilla and occulomotor disturbances.
Dr. Hutchins states that the facial artery is the principal artery involving flow of the anesthetic to the infraorbital maxillary area. This statement places the cart before the horse.
There is collateral circulation in the head and neck. The facial artery terminates in the area of the maxilla and infraorbital area, but this would not account for the other symptoms of occulomotor disturbance and the normal anesthesia of the inferior alveolar nerve. The facial artery is not located in the area of needle placement.
Dr. Hutchins is not a dentist. I assume he has never administered an inferior alveolar nerve block injection. I believe the discussion paragraphs in our article correctly depict flow of the anesthetic to result in the symptoms presented.
I invite Dr. Hutchins to review an excellent article with diagrams in October 2001 JADA, "Middle Ear Problems After a Gow-Gates Injection," by Drs. Charles D. Brodsky and James S. Dower Jr. This article’s diagrams depict the maxillary artery and its branches and shows needle placement for the injection. Dr. Hutchins also can coordinate this information with the Gray’s Anatomy textbook and the references quoted in our article.
