Techniques of mandibular anesthesia.pptx

Technique of insertion and mandibular Nerve Blocks

1. Techniques of mandibular anesthesia prathiba . E[ final year ] dpt of omfs

2. Mandibular nerve It is the branch of trigerminal nerve It is both motor as well as sensory Sensory located in semilunar or gasseriab ganglion Motor branch located in medulla oblongata and emerges out of foramen ovale

3. Definition of local anesthesia Local anesthesia is define as reversible loss of sensation in a circumscribed area of the body caused by depression of excitation in nerve endings or inhibition of the conduction process in peripheral nerves

4. Composition of local anesthesia Local anesthetic agent ; Lignocaine HCI 2%(20 mg/ml) Reducing agent; Sodium meta- bisulphite [0.5mg] Diluting agent ; Distilled water Vasoconstrictor; Adrenaline [0.012mg] Isotonic solution ; Ringer’s solution[6mg] Sodium hydroxide – to adjust pH VASOCONSTRICTORS OF L.A ; - Decrease blood flow to the site of injection – better visualization - Reduced systemic toxicity - More LA enters into nerve-Increase duration of action

5. Inferior alveolar nerve block O ther common name ; Mandibular Nerve Block Nerves anesthetized ; Inferior alveolar nerve Lingual nerve Incisive nerve Mental nerve Area Anasthetized ; Body of mandible, Inferior portion of ramus,Mucous membrane and structures anterior to mandibular 1 st molar

6. Indications ;Analgesia for surgical and operative dentistry on mandibular teeth and supporting structures, Diagnostic and therapeutic purposes Approximating structures when needle is in position ; The inferior dental nerve is blocked by the deposition of analgesic solution around it just before it enters the mandibular foramen and when it is in the pterygomandibular space This is bounded Anteriorly; pterygomandibular raphe Posteriorly ; parotid gland Laterally ; Ascending ramus of the mandible Medially ; medial pterygoid muscle Superiorly ; 2 heads of lateral pterygoid Inferiorly ; Attachment of medial pterygoid

7. ADVANTAGES; Wide area of anesthesia DISADVANTAGES; Inadequate anesthesia Intraoral landmarks Lingual and lower lip anesthesia Partial anesthesia bifid mandibular cannals

8. Technique Mouth open ,body of mandible parallel to floor Operator right side of patient Thumb palpates mucobuccal fold Thumb moves posteriorly to contact external oblique ridge on anterior border of ramus Greatest depth is identified Coronoid notch height of the mandibular sulcus . Syringe parallel to the occusal plane Opposite side of the mouth bisecting finger . Gently insert the needle , Needle withdrawn 1mm Solution deposit

9. COMPLICATION : High injectionnumbness of the ear – when injected in auriculotemporal nerve High injection – Trismus injection into lateral pterygoid High injection- Toxicity injection into pterygoid plexus of vein High and deep injection – Paralysis injection into Substance of parotid gland HEMATOMA Trancient facial paralysis - Injection into medial pterygoid

10. Buccal nerve block Nerve anesthetized Buccal nerve( a branch of the anterior division of V3) Area anesthetized Periosteum buccal to the mandibular molar teeth Techniques A 25- 27 gauge long needle is recommended this is most often used N Because the buccal nerve block is usually administered immediately after an IANB. Area of insertion mucous membranes distal and buccal to the most distal molar tooth in the arch Target area: buccal nerve as it passes over the anterior border of the ramus Landmarks : mandibular molars muccobucal fold

11. Advantages Technically easy Disadvantages Potential for pain if the needle contacts the periosteum during injection Complications: Few of any consequences Hematoma ( bluish discoloration and tissue swelling at the injection site)

12. The gow - gates technique Nerves anesthetized: Inferior Alveolar nerve Mental nerve Incisive nerve Lingual nerve Mylohyoid nerve Auriculotemporal nerve Area Anesthetized: Mandibular teeth to the midline

13. Buccal mucoperiosteum and mucous membranes on the side of injection Anterior two third of the tongue and floor of the oral cavity Lingual soft tissue and periosteum Techniques A 25or 27 gauge long needle recommended Area of insertion:Mucous membrane on the medial aspect of the mouth,just distal to the maxillary second molar Target area: lateral side of the condylar neck, just below the insertion of the lateral pterygoid muscle Landmarks Extra oral : The intertagic notch External auditory meatus concealed by the tragus

14. Corner of the mouth on the contralateral side Intra. Oral Height of the. Injection established by. Placement of.the needle tip. Just below the mesiolingual ( mesiopalatal ) cusp of the maxillary second molar . Penetration of soft tissue just distal to the maxillary second molar at the height established in the preceding step

15. Advantages: Relatively atraumatic Patient need not be able to open the mouth Fewer postoperative complications Disadvantages: Difficult to visualise the path of the needle and the depth of insertion No bony contact –depth of penetration somewhat arbitrary

16. Vazirani – akinosi technique Its primary indication remains those situations in which limited mandibular opening precludes the use of other mandibular injection techniques Nerves anesthetized ; Inferior alveolar nerve and its subdivision ,mental and incisive nerves and long buccal nerves Areas anesthetized ; All the mandibular hard and soft tissue to midline ,including floor of mouth and anterior 2/3 rd of tongue Anatomical landmarks ; occlusal plane of occluding teeth ; mucogingival junction of maxillarymolar teeth ; anterior border of ramus

17. COMPLICATIONS ; Hematoma Trismus TECHNIQUE A 25 – gauge long needle is recommended Area of insertion ; soft tissue overlying the medial border of the mandibular ramus directly adjacent to the maxillary tuberosity at the height of the mucogingival junction adjacent to the maxillary third molar

18. Mental nerve block The mental nerve is a terminal branch of inferior alveolar nerve Nerve anesthetized Mental nerve, terminal branch of the inferior alveolar nerve Area anesthetized; Buccal mucous membrane anterior to the mental foramen to the midline skin of the lower lip and chin

19. Technique A 25 or 27 gauge short needle recommended Area of insertion mucobuccal fold at or just anterior to the mental foramen Target area ; mental nerve as it exits the mental foramen [ usually located between the apices of the first and second premolars] Landmarks ; mandibular premolars and mucobuccal fold Position of the patient ; supine position is recommended

20. Complications ; Hematoma Paresthesia of lip and chin

21. Incisive nerve block It is a terminal branch of inferior alveolar nerve Nerve anesthetized ; Mental and incisive nerve Areas anesthetized ; Buccal mucous membrane anterior to the mental foramen ,usually from the second premolar to the midline Lower lip and skin of the chin Pulpal nerve fibers to the premolars, canine and incisors

22. Technique ; A 27 gauge short needle is recommended Area of insertion ; Mucobuccal fold at or just anterior to the mental foramen Target area ; Mental foramen , through which the mental nerve exits and inside of which the incisive nerve is located Landmarks ; Mandibular premolars and mucobuccal fold Position of the patient ; Supine and semisupine position is recommended

23. Complications ; Hematoma Paresthesia of lip and chin