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Local Anaesthetics > ICP-32 Clinically Relevant Anatomy > Flashcards

ICP-32 Clinically Relevant Anatomy Flashcards

1
Q

What are the 12 Cranial Nerves

A 
1 - Olfactory
2 - Optic
3 - Oculomotor
4 - Trochlear
5 - Trigeminal
6 - Abducens
7 - Facial
8 - Vestibulocochlear
9 - Glossopharyngeal
10 - Vagus
11 - Accessory
12 - Hypoglossal
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2
Q

What does the trigeminal nerve innervate

A

The muscles of mastication, facial expression and the sinuses and teeth

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3
Q

What is the largest cranial nerve

A

The trigeminal nerve

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4
Q

Is the trigeminal nerve mainly sensory or motor

A

Sensory

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5
Q

What are the 3 main branches of the trigeminal nerve

A

Ophthalmic (V1)
Maxillary (V2)
Mandibular (V3)

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6
Q

What do the branches of the Maxillary division of the trigeminal nerve innervate

A

The upper teeth and their supporting structures

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7
Q

What branches of the Maxillary division of the trigeminal nerve are important in anaesthetics

A
  • Posterior superior alveolar nerve
  • Middle superior alveolar nerve
  • Anterior superior alveolar nerve
  • Nasopalatine nerve
  • Greater and lesser palatine nerves
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8
Q

What structures does the posterior superior alveolar nerve innervate

A

Second and third molars, distobuccal and palatal cusp of the first molar and adjacent gingiva, mucosa, periodontium and buccal alveolar bone

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9
Q

What structures does the middle superior alveolar nerve innervate

A

Mesiobuccal cusp of the first molar, premolars and adjacent gingiva, mucosa and periodontium and buccal alveolar bone

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10
Q

What structures does the anterior superior alveolar nerve innervate

A

Canines, incisors and adjacent buccal gingiva, mucosa, periodontium and buccal alveolar nerve

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11
Q

What structures does the greater palatine nerve innervate

A

Palatal mucosa and bone adjacent to molars and premolars and canines

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12
Q

What structures does the lesser palatine nerve innervate

A

Soft palate and uvula

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13
Q

What structures does the nasopalatine nerve innervate

A

Palatal mucosa and bone adjacent to incisors and canines

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14
Q

Where is anaesthesia deposited to anaesthetise maxillary teeth and why

A

At the buccal side of the maxilla that infiltrates to the pulp of the teeth to produce anaesthesia this is because the cortical plate on the buccal side of the maxilla is thin, by injecting the solution above one tooth you will often get anaesthesia of adjacent teeth as well

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15
Q

Where would we aim to inject the LA and what structures will the needle pass through to get there

A

The stratified squamous epithelium and keratinised layer, through the lamina propria and aim to deposit the LA in the CT layer above the periosteum and bone, whilst trying to avoid any main vessels

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16
Q

Where does the nasopalatine nerve exit the maxilla

A

Incisive papillae

17
Q

Where does the greater and lesser palatine nerves exit the maxilla

A

At the greater and lesser palatine foramen

18
Q

What LA administration techniques are there in the palate

A

Infiltration or block techniques

19
Q

Infiltration of how much LA deposited where will anaesthetise the palatal tings

A

0.2 ml into the palatal mucosa just distal to the tooth of interest

20
Q

What will infiltration of the palatal mucosa anaesthetise

A

The palatal mucosa and periodontium anterior to the point of infiltration up to the canine region

21
Q

When carrying out palatal infiltrations what is different about the upper third molar and why

A

Unlike all other teeth the infiltration of the upper third molar, the solution should be deposited at the anterior aspect of the tooth as the greater palatine foramen lies anterior to the third molar tooth and the nerve supplying this region travels in a posterior region

22
Q

When anaesthetising the anterior region (canines and beyond i think) what kind of LA admin is preferred

A

Nasopalatine nerve block

23
Q

How do you know whether or not to anaesthetise both the palatal mucosa and main nerve supply

A

Depends on procedure:

Extraction = both buccal and palatal nerve supply

Restorative procedures - usually anaesthesia of the main nerve supply is enough

24
Q

What structures does the inferior alveolar nerve innervate

A

Mandibular teeth and alveolus

25
Q

What structures does the long buccal nerve innervate

A

Buccal gingiva and mucosa opposite molars and premolars

26
Q

What structures does the mental nerve innervate

A

Buccal gingiva and mucosa opposite premolars, canines and incisors, skin and mucosa of the lower lip and chin

27
Q

What structures does the lingual nerve innervates

A

Anterior 2/3 of the tongue, gingiva, mucosa and floor of the mouth

28
Q

What kind of LA administration do we need to use in mandibular teeth and why

A

Regional nerve block as the cortical bone is too thick so we need to inject the LA near the nerve trunk

29
Q

What is the conventional method used to anaesthetise teeth in the mandible

A

Inferior alveolar nerve block (IANB) - Can use infiltration for the mandibular anterior teeth where the cortical plate is thinner

30
Q

What are the advantages of infiltration LA administration

A
  • Simple

- When successful it anaesthetises all nerve endings in the area

31
Q

What are the disadvantages of infiltration LA administration

A
  • LA must diffuse through bone
  • Localised infection may be spread if an inflamed area is infiltrated
  • Only a limited zone of anaesthesia per injection
32
Q

What are the advantages of regional block techniques

A
  • Anaesthetic delivered to a major nerve
  • Blocks sensation downstream of the injection site
  • The more proximal the block, the greater the affected area
  • Widespread anaesthesia from one injection
  • Anaesthetic can be injected away from infected areas
33
Q

What are the disadvantages of regional block techniques

A
  • Regional blocks require complete knowledge of the anatomy and are harder to perform
  • Does not anaesthetise nerve endings from different trunks - in the midline
  • Excessive soft tissue anaesthesia
  • May cause haemorrhage in patients with bleeding disorders
  • Potential for injury to a nerve trunk
34
Q

What does the mandibular foramen function as

A

Entrance to the mandibular canal that transmits the inferior alveolar vessels and nerves to the roots of the mandibular teeth

35
Q

What happens at the mental foramen

A

Branches of inferior alveolar vessels and mental nerve emerge from the mandibular canal at the mental foramen

36
Q

What does the lingual do

A

Thin tongue like projection of bone that overlaps and guards the superior border of the foramen - has some role in IANB techniques?

Local Anaesthetics (4 decks)

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