Lets face it, a trip to the Oral Facial Surgeon is usually associated with a high level of anxiety. A major part of our practice is to provide a comfortable environment with different levels of anesthesia to make your visit a pleasant one. We offer the following anesthetic choices.

Local Anesthesia

Local anesthesia refers to the administration of an anesthetic agent (usually Lidocaine) as a regional nerve block or infiltration nerve block in the area of the surgery. The patient is “numb” and may feel a pressure sensation. The patient is conscious throughout the procedure. This method of anesthesia is sufficient for minor biopsies, simple extractions, minor oral facial procedure, and soft tissue procedures. We administer local anesthesia in all surgical procedure we perform irrespective if additional anesthetic options are chosen, ie nitrous oxide, IV sedation, or general anesthesia.

Nitrous Oxide with Local Anesthetic

Nitrous Oxide, known as laughing gas, is an inhalation mixture of Nitrous Oxide and Oxygen administered nasally. Although the patient remains conscious, they are relaxed and mildly sedated. Nitrous Oxide has some analgesic  (pain relieving) properties. Nitrous Oxide has several advantages in that it works rapidly and reverses rapidly and has no hangover effect, The effect is reversed before the patient is discharged. This method is often chosen for minor biopsies, simple extractions, and minor oral facial procedures.

Office IV Anesthesia and General Anesthesia with Local Anesthesia

This is recommended for healthy individuals experiencing high levels of anxiety and is available for use with all types of office based oral facial surgery. Patients are required to have had nothing to eat or drink for 8 hours. An intravenous catheter is placed and medications (benzodiazepam agent Versed, a narcotic, and a dissociative agent)  are administered to achieve the desired level of patient comfort and amnesia. IV fluids are also administered to help correct the fluid deficit from being NPO (nil per os, meaning no oral food or fluids). The anesthesia can range from a light to deep sedation, to a twilight sleep state. Patients receive supplemental nasal oxygen, and vital signs are monitored for blood pressure, blood oxygenation through pulse oxymetry, and an EKG. Local anesthesia nerve block is also used so when the patient is discharged, they are not experiencing discomfort from the procedure.

Hospital or Surgery Center Anesthesia

This method of anesthesia is utilized for either patients whose medical condition is a contraindication for office based IV anesthesia (for example certain heart and lung diseases), or those individuals undergoing procedures better managed in a operating room environment. This includes some pathology, most facial fractures, jaw reconstruction, and facial reconstruction. The anesthesia is administered by an anesthesiologist and an anesthesia team.


Oral Facial Surgery is unique in that the administration of anesthesia is a part of the specialty in which Drs. Gonzalez, Maniscalco or Carr are licensed to practice. The Oral and Maxillofacial Surgery residency programs have board regulated mandatory requirements for hospital based anesthesia training, with residents serving a required number of months functioning as an anesthesia resident. To become board certified by the American Board of Oral and Maxillofacial Surgery, Drs. Gonzalez, Maniscalco or Carr had to successfully pass written and orally examinations in many areas, including anesthesia. Once in private practice, the doctors were tested and the office was inspected by state board examiners to be in compliance with board requirements. Drs. Gonzalez, Maniscalco or Carr were issued and maintain a current license  to administer office anesthesia. Drs. Gonzalez, Maniscalco or Carr are also ACLS and CPR certified. All staff employees are current in CPR training. Our priority is providing you a comfortable experience, excellent care, with the utmost attention to safety.