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Pain and Anxiety > LA in the Mandible > Flashcards

LA in the Mandible Flashcards

1
Q

What are the branches of V3

A

1) Undivided nerve
-medial pterygoid branch
-dura mater branch
2) Anterior division
-lateral pterygoid branch
-masseter muscle branch
-temporal muscle branch
-long buccal nerve
3) Posterior division
-auriculotemporal branch
-lingual nerve
-mylohyoid nerve
-inferior alveolar nerve
-mental nerve
-incisive nerve - terminal branches

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2
Q

What are the 4 major branches of V3

A

IAN
Lingual
Long buccal
Mental

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3
Q

What are the mandibular injections

A

1) Conventional mandibular block
2) Gow-gates mandibular block
3) Uni-linear madibular block
4) Vazirani-Akinosi mandibular block
5) Mental nerve block
6) Mylohyoid nerve block

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4
Q

What is the most challenging area of oro-face to anesthetize and why?

A

IAN b/c:
-structural complexity of the mandibular division (V3)
-entire division is freely moveable along with the mandibular structures which it innervates
-bone is more compact –> local infiltration of anesthetic is NOT effective

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5
Q

What does IAN provide sensation to?

A

-Mandibular teeth
-Body of the mandible, inferior portion of the ramus
-Buccal mucoperiosteum, muscus membrane anterior to the mental foramen

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6
Q

What is the path of the IAN

A

-Descends inferiorly and laterally across the pterygoid space
-Forms 2 branches = Lingual nerve (anteriorly) and Mylohyoid nerve (posteriorly)
-Enters into mandibular foramen
-Traverses beneath the roots of the mandibular teeth to the mental foramen
-Divides into: Mental nerve and Terminal IAN branches

*Terminal IAN branches can cross the midline - usually to opposite incisors but can extend to opposite mandibular foramen

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7
Q

What is the path of the lingual nerve

A

-Descends inferiorly and medially between the ramus and medial pterygoid muscle
-Runs anterior and slightly medial to the inferior alveolar nerve
-Runs just distal and medial to the third molar
-Extends inferiorly to the tongue

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8
Q

What does lingual nerve provide sensation to

A

-Anterior two-thirds of tongue
-Floor of the mouth
-Lingual gingiva

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9
Q

What is the path of the long buccal nerve

A

-Branches off anterior division of V3
-Descends parallel to the lingual nerve and IAN
-At retromolar pad, swings laterally and fans up and out over the area of the buccal mucosa

**Also known as the buccal nerve

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10
Q

What does the long buccal nerve provide sensation to?

A

-Buccal gingiva of molar/premolar area
-Skin of the cheek
-NO innervation of the lip

*Some overlap between terminal branches of Long buccal nerve and Mental nerve

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11
Q

What does the mandibular block anesthetize

A

Using 1 anesthetic carpule:

  • IAN
  • Lingual nerve
  • long buccal nerve
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12
Q

What are the types of mandibular blocks

A

1) Conventional mandibular block
2) Uni-linear mandibular block
3) Gow-Gates mandibular block
4) Vazirani-Akinosi mandibular block

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13
Q

What are the target zones for the conventional mandibular block

A

There are two target zones:
-Posterior Zone: includes both the IAN and Lingual nerve

-Anterior Zone: includes the Long Buccal nerve and is targeted in a separate injection

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14
Q

What is the posterior target area in the conventional mandibular block and what is it defined by?

A

Posterior Target = Retromolar Triangle: Inferior alveolar nerve as it passes downward to the mandibular foramen but prior to entry into foramen

Defined By:
1) Pterygomandibular raphe medially
2) Anterior border of the ramus laterally
3) Hamular notch superiorly

*The target area is characterized by a dimple or depression found roughly in the center of the triangle

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15
Q

What are parameters to consider for conventional mandibular block

A

1) Height of injection (6-10mm above occlusal plane)
2) A-P placement of needle - 3/4 of the A-P distance from the coronoid notch back to deepest part of pterygomandibular raphe
3) Depth of penetration - until bone is contacted. ~20-25mm in depth or 2/3-3/4 depth of long needle

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16
Q

What needle is used for conventional mandibular block

A

25 long

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17
Q

Where do you insert needle in conventional mandibular block

A

Align barrel of syringe with contralateral premoalrs - parallel with occlusal plane

Insertion to about 2/3 to 3/4 length until bone in contacted

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18
Q

Facts for conventional mandibular block

A

-25 long needle is used
-Align barrel of syringe with contralateral premolars - parallel with occlusal plane
-Insertion is made about 2/3 - 3/4 needle length until bone is contacted
-Bevel is toward the bone
-Positive aspiration common
-After reaching the target –> slowly deposit the entire carpule except 0.2cc carpule

19
Q

What is the posterior target zone in the conventional mandibular block

A

Defined by:
1) the deepest extent of the mesial concavity of the ascending ramus
2) the deepest extent of the posterior concavity of the ramus

20
Q

What is present in the posterior target zone in conventional mandibular block

A

the lingula is present

21
Q

What happens when the lingula is presenting a barrier in conventional mandibular block

A

Penetrate dimple then swing barrel of the syringe toward the midline in order to reach the posterior target area

22
Q

What is the anterior target area of the long buccal nerve block

A

Anterior border of the ramus

23
Q

What is the penetration for long buccal block

A

Penetration of the mucosa is made:
-distal and buccal to the most distal molar tooth in the arch
-needle parallel to occlusal plane but buccal to the teeth
-reposition needle if necessary (shallow tissue) = 45 degree angle/laterally

24
Q

What needle is used for long buccal block

A

25 long

25
Q

Technique for long buccal nerve block

A

-25 long needle is used
-Insertion is made until bone is contacted –> 1-4mm
-**Make sure bevel is buried
-Bevel is toward the bone
-Deposit 0.2cc

26
Q

What is the target zone for Gow Gates mandibular block

A

Target zone is significantly superior to the target zone of the conventional block

27
Q

What are stats about the technique of Gow Gates

A

-High success rate (requires experience)
-Longer onset of anesthesia
-Low aspiration rate
-Successful anesthesia with bifid IAN/bifid mandibular canals

28
Q

What is the target area/penetration of Gow gates

A

Target area:
-Anteromedial side of condylar neck

Penetration of the mucosa:
-Needle placed just disal to the max 2nd molar at the height of the tip of the MLi cusp (3rd molar if present)
-Syringe barrel aligned with the imaginary line between intertragus notch (injection side) and the corner of the mouth (opposite side)
-make sure bone is contacted
-Sit pt upright for 5min with mouth open for 1-2min

29
Q

What needle is used for Gow gates

A

25 long

30
Q

Where is uni-linear block target zone

A

Approximately 1cm superior to the target zone for conventional mandibular block is an area where the IAN, the lingual nerve, and the long buccal nerve are closest together
—> running parallel
—> in close proximity
—> in a straight line

31
Q

What is the target area/penetration of uni-linear mandibular block

A

Target area:
-1cm superior to conventional mandibular block target

Penetration of the mucosa:
-5mm above dimple of posterior triangle –> insert to 1/2 - 2/3 needle length
-swing barrel to opposite side –> advance until bone is contacted
-withdraw 2mm and deposit 3/4 carpule
-slowly withdraw, depositing remaining carpule (anesthesizes Li and Long Buccal)

32
Q

Target area/penetration of Vazirani-Akinosi block

A

Target area:
-medial border of ramus

Penetration of the mucosa:
-Mouth is closed; light occlusion
-Syringe barrel is parallel to maxillary occlusal plane
-Needle is inserted at mucogingival junction of maxillary 2nd molar and advanced in a slightly lateral direction
*bone is NOT contacted

33
Q

What needle used for Vazirani-Akinosi block

A

25 long

34
Q

What is important in technique about Vazirani-Akinosi block

A

Bevel is AWAY from mandibular ramus - critical

35
Q

Technique for Vazirani-Akinosi block

A

-25 long needle is used
-Insertion is made to about 3/4 needle length from the maxillary tuberosity
-Bevel is AWAY from the mandibular ramus
-Use a full carpule = 1.8cc
*sit pt upright

36
Q

What are the mandibular accessory injections

A

Mental nerve block
Mylohyoid nerve block

37
Q

Mental nerve block target area

A

Target area:
mental foramen, usually between apices of 1st and 2nd premolar

38
Q

What needle for mental nerve block

A

25 long or 27 short

39
Q

Technique for mental nerve block

A

-Insertion is made deep enough to bury the bevel of the needle
-Bevel is toward the bone
-Use 1/2 carpule
*apply pressure on the area that has “ballooned”

40
Q

What is indication for mylohyoid nerve block

A

When a successful mandibular block has been given but pt still has sensation in some mandibular teeth (particularly molars)

41
Q

What is the target area/penetration of the mylohyoid block

A

Target area:
-Lingual approach
-Just medial to mandibular 2nd molar

Penetration of the mucosa:
-Depth of the lingual vestibule
-45 degree angle to the long axis of the molar

42
Q

What needle for mylohyoid nerve block

A

25 long or 27 short

43
Q

Technique for mylohyoid nerve block

A

-Insertion is made to about 1/4 to 1/3 the needle length until bone is contacted (lingual border of body of mandible)
-Bevel is toward the bone
-Use 1/2 carpule

Pain and Anxiety (12 decks)

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