Anesthetic Blocks for Orofacial Pain

Question 1

Indications for a Anesthetic Block for Orofacial Pain?

Answer 1

• Diagnostic Injections
  
  • help establish dx
  • primary vs secondary pain
• Pt Education
• Therapeutic:
  
  • Myofascial pain
  • break Pain cycle
  • Acute Myospasm

Question 2

Contraindications for a Anesthetic Block for Orofacial Pain?

Answer 2

• Infection at site of injection
• Bleeding disorder
• Anticoagulant agents
• Allergic to anesthetic
• Anxiety
• State Dental Practice Act/Law

Question 3

What are the different types of Injections?

Answer 3

• Muscle Injections
• Nerve Block
• Intracapsular Injections

Question 4

General Rules to follow

Answer 4

• Know anatomy of all structures in region
• Know about anesthetic solution
  
  • different for muscle vs nerve block injections
• Maintain strict apsesis
• Always aspirate before injection

Question 5

Anesthetic for muscle injections

Answer 5

• Short Acting Drug: for Dx
  
  • 0.5% procaine w/o vasoconstritor
  • 2% lidocaine w/o vasoconstrictor
  • 3% mepivacaine w/o vasoconstrictor
• No Long Acting anesthetics due to ⇡ myotoxicity
  
  • bupivacaine (marcaine)

Question 6

Anesthetic for Nerve Block Injections

Answer 6

• Diagnostic:
  
  • 3% mepivacaine w/o vasoconstrictor
• Therapeutic:
  
  • 0.5% bupivacaine w/vasoconstrictor

Question 7

Trigger Point injections

Answer 7

1. Locate:
   
   1. taut band
   2. most painful area
2. Trap trigger point b/w 2 fingers
3. Insert needle into tissue
   
   • get patient feedback
   • watch for twitch response

Question 8

Nerve Block Injections

Answer 8

• Diagnostic
  
  • identify source of pain
• Types:
  
  • Dental Blocks
  • infraorbital nerve block
  • auriculotemporal nerve block

Question 9

Dental Blocks

Answer 9

• Types:
  
  • IAN
  • Posterior Superior Nerve Block
  • Mental Nerve Block
  • Infiltration

Question 10

IAN Nerve Block

Answer 10

• eliminates any source of pain from mandibular teeth
• separates dental pain from muscle or joint pain

Question 11

Auriculotemporal Nerve Block: General

Answer 11

• if TMJ is source of pain
  
  • eliminate pain quickly

Question 12

Auriculotemporal Nerve Block: Technique

Answer 12

• Place needle anterior to the Jxn of tragus and earlobe
• Touch the posterior neck of the condyle
• Reposition needle more posterior
  
  • until tip is behind the posterior neck of condyle

Question 13

What nerves innervate the TMJ?

Answer 13

• Primary:
  
  • auriculotemporal Nerve
• Secondary:
  
  • Masseter N
  • Posterior deep temporal N

Question 14

Infraorbital Nerve

Answer 14

• Exits infraorbital foramen
• location:
  
  • inferior border of orbit
• Innervates:
  
  • facial structures below the eye
  • Lateral nose
• Trauma → continuous neuropathic pain

Question 15

Infraorbital Nerve Block

Answer 15

• Extraoral Approach
  
  • Find foramen by palpating inferior border of orbit
    
    • feel for slight notch
  • Clean tissue around area
  • Place needle in the foramen
    
    • depth of the notch
• Intraoral Approach
  
  • Locate notch extraorally
  • Use middle finger to maintain position of notch
    
    • index finger and thumb to retract lip
  • Insert needle into vestibule
    
    • up toward the notch

Question 16

TMJ Intracapsular Injections: General

Answer 16

• Indication:
  
  • therapeutic reasons
• Target:
  
  • superior joint space

Question 17

TMJ Intracapsular Injections: Technique

Answer 17

• Ask the patient to open and close mouth
  
  • to locate the lateral pole of the condyle
• Ask patient to open slightly
• Palpate directly above to locate zygomatic arch
• clean w/alcohol
• Place needle below zygomatic arch
  
  • behind posterior and superior aspect of the condyle
• Angle needle anterior-superiorly
  
  • avoid the retrodiscal tissues and ear structures
• After penetrating capsule, needle is in superior joint space
• Deposit solution
• Remove Needle and Place Steril Gauze
• Ask patient to open and close a few times
  
  • to distribute solution throughout joint space
• Success→immediate ipsilateral side occlusion
  
  • resolve in few hours
  • make patient aware so it does not cause concern or emotional stress

Question 18

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