Local Anesthesia pt. 8 Flashcards by sophie rosen

Buccal Nerve
Between

Lateral Pterygoid Heads

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Buccal Nerve
Sensory to (2)

Cheek Area
Molar Buccal Gingiva

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Buccal Nerve Block
Injection – (3)

Injection – 25 Gauge Long Needle
Injection – Stretch Tissue
Injection – Contact Periosteum

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Buccal Nerve Block
Tissues Anesthetized
(4)

•Gingiva buccal to molars
•Retromolar pad mucosa
•Buccal mucosa in molar area
•NO hard tissues anesthetized

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Buccal Nerve Block
Indications

•When buccal soft tissue
anesthesia is required

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Buccal Nerve Block
Advantages
(3)

•High success rate
•Easy injection to administer
•Atraumatic

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Mandibular Nerve
Posterior Division
(5)

•Primarily sensory
•Auriculotemporal nerve
•Lingual nerve
•Inferior alveolar nerve
•Mylohyoid nerve

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Auriculotemporal Nerve
Areas Innervated
(5)

•Skin over areas supplied by VII
•Skin over helix and tragus of ear
•Skin of external auditory meatus
•Posterior part of TMJ
•Skin over temporal area

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Lingual Nerve
(3)

Second Branch of Posterior Division
Innervates Anterior 2/3 of Tongue
Innervates Lingual Mucosa

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Lingual Nerve Blocked With:
(5)

•Inferior Alveolar Block
•Mandibular Block
•Gow-Gates Mandibular Block
•Vazirani-Akinosi Block
•Infiltration in lingual sulcus

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Lingual Nerve Blocked With:

Infiltration in lingual sulcus

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Inferior Alveolar Nerve
steps (probs skip)

Largest Branch of Posterior Division
Sphenomandibular Ligament
Mandibular Foramen
Syringe at Level of Coronoid Notch
Syringe Directed Across Arch
Needle Penetrates Buccinator
Muscle
Penetration Lateral to
Pterygomandibular Raphe
Drying the Injection Site
Apply Topical Anesthetic
Wait One to Two Minutes
Finger on Notch Retracts Cheek and
Determines Height of Injection
Note Site of Needle Insertion
Barrel of Syringe in Corner of Mouth
Aspirate, Inject 1.5 ml over 60 Sec.
Insert~25mm to Contact Bone
Withdraw Halfway, Deposit 0.1 ml at
Lingual Nerve

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Inferior Alveolar Nerve Block
Nerves Anesthetized
(4)

•Inferior alveolar
•Incisive
•Mental
•Lingual (usually)

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Inferior Alveolar Nerve Block
Indications
(3)

•Wide area requires anesthesia
•Buccal tissue anesthesia is needed
•Lingual soft tissue anesthesia is
needed

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Inferior Alveolar Nerve Block
Contraindications
(3)

•Infection in area
•Acute inflammation in area
•Patient a potential lip-biter

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Inferior Alveolar Nerve Block
Advantages
(2)

•Provides wide area of anesthesia
•Minimizes anesthetic dose

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Inferior Alveolar Nerve Block
Disadvantages
(4)

•Wide area anesthetized
•Unsuccessful in 15 to 20%
•Inconsistent oral landmarks
•10-15% positive aspiration

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Inferior Alveolar Nerve Block
Alternatives
(5)

•Mental nerve block
•Incisive nerve block
•Gow-Gates block
•Vazirani-Akinosi block
•Intraosseous or intraseptal
injection

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Terminal Branch of Inferior Alveolar

Mental Nerve

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Mental Nerve Block
steps (5)

Palpate the Mental Foramen
Determine Site of Injection
Dry the Area and Apply Topical
Orient Needle Bevel Facing Bone
Insert into Tissue Over Foramen

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Insert into Tissue Over Foramen
Deposit — ml over —
seconds.

0.6
20

Mental Nerve Block
Areas Anesthetized
(3)

•Mucosa anterior to foramen
•Skin of the lower lip
•Chin

Mental Nerve Block
Indications
(3)

•Soft tissue anesthesia
•Suturing lip lacerations
•Biopsies of lip tissue

Mental Nerve Block
Contraindications
(2)

•Infection in the area
•Acute inflammation

Mental Nerve Block Advantages (3)

•High success rate •Technically easy •Usually entirely atraumatic

Mental Nerve Block Disadvantages (2)

•Hematoma •Positive aspiration 5.7 %

Terminal Branch of Inferior Alveolar

Incisive Nerve

ncisive Nerve Supplies (3)

Incisors, Canine, Premolar(s)

Incisive Nerve Block (2)

Identical to Mental Block With Pressure Maintained 2 Minutes Trans-Papilla Injection for Lingual Anesthesia

Incisive Nerve Block Areas Anesthetized (4)

•Mucosa on buccal •Lower Lip •Skin of the chin •Premolars, canines, incisors

Incisive Nerve Block Indications (3)

•Procedures on anterior teeth •When inferior alveolar block is not indicated •To avoid bilateral mandibular blocks

Incisive Nerve Block Contraindications (2)

•Infection •Acute inflammation

Incisive Nerve Block Advantages (2)

•Provides pulpal and hard tissue anesthesia without lingual anesthesia •High success rate

Incisive Nerve Block Disadvantages (3)

•No lingual anesthesia •May be sensory overlap at midline (rare) •Positive aspiration 5.7 %

True Mandibular Nerve Block

Gow-Gates Nerve Block

Gow-Gates Nerve Block Needle Contacts

Neck of Condyle

Gow-Gates Nerve Block Two Extra-oral Landmarks (2)

Intertragic notch Corner of mouth

Gow-Gates Nerve Block Wide Opening, Condyle Moves

Forward

Gow-Gates Nerve Block Needle Puncture Point Dictated by

Intra-oral Landmarks

Gow-Gates Nerve Block steps (2)

Advance Until Bone Contacted Withdraw 1 mm, Aspirate, Inject 1.8 ml

Gow-Gates Nerve Block Nerves Anesthetized (5)

•Inferior Alveolar •Lingual •Mylohyoid •Auricolotemporal •Buccal (in 75 %)

Gow-Gates Nerve Block Indications (4)

•Multiple procedures •Buccal anesthesia required •Lingual anesthesia required •Minimal dose of anesthetic

Gow-Gates Nerve Block Contraindications (4)

•Infection in area •Inflammation in area •Potential lip-biter •Restricted mouth opening

Gow-Gates Nerve Block Advantages (4)

•95-99% success rate ! •Single injection •Minimal aspiration rate •Few complications

Gow-Gates Nerve Block Disadvantages (2)

•Longer onset, >5 minutes) •No intraoral landmarks

Vazirani-Akinosi Nerve Block (3)

Direct Parallel to Ramus Insert to 25 mm Depth Aspirate, Inject 1.5 to 1.8 ml

Vazirani-Akinosi Nerve Block Nerves Anesthetized (3)

•Inferior Alveolar •Lingual •Mylohyoid

Vazirani-Akinosi Nerve Block Indications (3)

•Limited mouth opening •Multiple procedures planned •Landmarks poorly visible for other injections

Vazirani-Akinosi Nerve Block Contraindications (4)

•Infection in area •Inflammation in area •Potential lip-biter •Inadequate access

Vazirani-Akinosi Nerve Block Advantages (3)

•Relatively atraumatic •No need to open mouth •Aspiration rate <10 %

Vazirani-Akinosi Nerve Block Disadvantages (3)

•Difficult visualization •No bony contact •Arbitrary insertion depth