mandibular_nerve_block (1)1111111111.ppt

mandibular_nerve_block (1).ppt

1. Techniques of Mandibular Techniques of Mandibular
AnesthesiaAnesthesia

2. Mandibular AnesthesiaMandibular Anesthesia
Lower success rate than Maxillary anesthesia Lower success rate than Maxillary anesthesia
- approx. 80-85 %- approx. 80-85 %
Related to bone densityRelated to bone density
Less access to nerve trunks  Less access to nerve trunks  

3. Mandibular Nerve BlocksMandibular Nerve Blocks
Inferior alveolarInferior alveolar
Mental - Incisive Mental - Incisive
BuccalBuccal
LingualLingual
Gow-GatesGow-Gates
AkinosiAkinosi

4. Mandibular AnesthesiaMandibular Anesthesia
Most commonly performed techniqueMost commonly performed technique
Has highest failure rate (15-20%)Has highest failure rate (15-20%)
Success depends on depositing solution within 1 mm of Success depends on depositing solution within 1 mm of
nerve trunknerve trunk

5. Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block
Not a complete mandibular nerve block.Not a complete mandibular nerve block.
Requires supplemental buccal nerve blockRequires supplemental buccal nerve block
May require infiltration of incisors or mesial May require infiltration of incisors or mesial
root of first molarroot of first molar

6. Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block
Nerves anesthetizedNerves anesthetized
Inferior AlveolarInferior Alveolar
MentalMental
Incisive Incisive
LingualLingual

7. Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block
Areas AnesthetizedAreas Anesthetized
Mandibular teeth to midlineMandibular teeth to midline
Body of mandible, inferior ramus Body of mandible, inferior ramus
Buccal mucosa anterior to mental foramenBuccal mucosa anterior to mental foramen
Anterior 2/3 tongue & floor of mouthAnterior 2/3 tongue & floor of mouth
Lingual soft tissue and periosteumLingual soft tissue and periosteum

8. Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block
IndicationsIndications
Multiple mandibular teethMultiple mandibular teeth
Buccal anterior soft tissueBuccal anterior soft tissue
Lingual anesthesiaLingual anesthesia

9. Inferior Alveolar Nerve Block Inferior Alveolar Nerve Block
ContraindicationsContraindications
Infection/inflammation at injection siteInfection/inflammation at injection site
Patients at risk for self injury (eg. children)Patients at risk for self injury (eg. children)

10. Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block
10%-15% positive aspiration10%-15% positive aspiration

11. Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block
AlternativesAlternatives
Mental nerve blockMental nerve block
Incisive nerve blockIncisive nerve block
Anterior infiltrationAnterior infiltration

12. Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block
Alternatives (cont.)Alternatives (cont.)
Periodontal ligament injection (PDL)Periodontal ligament injection (PDL)
Gow-GatesGow-Gates
Akinosi Akinosi
IntraseptalIntraseptal

13. Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block
TechniqueTechnique
Apply topicalApply topical
Area of insertionArea of insertion::
medial ramus, mid-coronoid notch,medial ramus, mid-coronoid notch,
level with occlusal plane (1 cm above),level with occlusal plane (1 cm above),
3/4 posterior from coronoid notch to 3/4 posterior from coronoid notch to
pterygomandibular raphepterygomandibular raphe
advance to bone (20-25 mm)advance to bone (20-25 mm)

14. Inferior Alveolar Nerve Block Inferior Alveolar Nerve Block
Target AreaTarget Area
Inferior alveolar nerve, near mandibular foramenInferior alveolar nerve, near mandibular foramen

LandmarksLandmarks
Coronoid notchCoronoid notch
Pterygomandibular raphePterygomandibular raphe
Occlusal plane of mandibular posteriorsOcclusal plane of mandibular posteriors

15. Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block
PrecautionsPrecautions
Do not inject if bone not contactedDo not inject if bone not contacted
Avoid forceful bone contactAvoid forceful bone contact

16. Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block
Failure of AnesthesiaFailure of Anesthesia
Injection too lowInjection too low
Injection too anteriorInjection too anterior
Accessory innervationAccessory innervation
-Mylohyoid nerve-Mylohyoid nerve
-contralateral Incisive nerve innervation-contralateral Incisive nerve innervation

17. Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block
ComplicationsComplications
HematomaHematoma
TrismusTrismus
Facial paralysisFacial paralysis