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Module 3: Local anaesthesia > Mandibular anaesthesia > Flashcards

Mandibular anaesthesia Flashcards

1
Q

label the diagram showing the branches of the mandibular devision of the trigeminal nerve.

A
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2
Q

Explain how the mental and incisive nerve arise from the inferior alveolar nerve.

A
  • IAN enters mandible through mandibular foramen, passes through and along body of mandible passing towards the chin as incisive nerve, it branches and leaves mental foramen between premolars as mental nerve.
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3
Q

what teeth does the inferior alveolar nerve innervate

A
  • IAN supplies the molars and pre-molars
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4
Q

what teeth does the incisive nerve innervate?

A
  • canines and incisors
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5
Q

Where does the lingual nerve go after branching from mandibular devision?

A
  • lingual nerve passes towards the tongue without entering mandible.
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6
Q

WhIch nerve innervates the lingual soft tissues?

A
  • lingual nerve
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7
Q

which soft tissues does the long buccal nerve innervate in the mandible?

A
  • supplies buccal soft tissues adjacent to molars only
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8
Q

Which soft tissues does the mental nerve innervate?

A
  • innervates soft tissues adjacent to premolars and anterior teeth
    • labial sulcus and the lower lip
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9
Q

What are the 5 different types of block anaesthesia in the mandible? what do they each anaesthetise?

A
  1. Inferior alveolar nerve block - lower teeth
  2. Long buccal nerve - buccal mucosa of posterior molars
  3. lingual nerve - all lingual soft tissues
  4. mental nerve block - labial soft tissues incl. lower lip
  5. incisive nerve block - lower incisors (not carried out because there is nerve block cross over)
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10
Q

What is the Halstead approach for inferior alveolar nerve block?

A
  • it is a direct technique where we try to get needle to target in one movement
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11
Q

Where is the mandibular foramen located?

A
  • the mandibular foramen is perpendicular to mandibular occlusal plane / approx. in line with mandibular plane
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12
Q

label the diagram below showing surroundings of the inferior alveolar nerve. Where should the needle go in terms of the structures labelled.

A
  • The needle should be lateral to the pterygomandibular raphe, passing through buccinator muscle.
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12
Q

label the diagram below showing surroundings of the inferior alveolar nerve. Where should the needle go in terms of the structures labelled.

A
  • The needle should be lateral to the pterygomandibular raphe, passing through buccinator muscle.
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13
Q

Where does IAN block aim to deposit LA?

A
  • close to IAN

- before it enters mandible (doesnt work if you inject where it is in the mandible)

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14
Q

what are the lateral, medial, posterior, anterior and superior structures to the mandibular foramen in the pterygomandibular space

A
  • Lateral structure: ramps of mandible
  • medial structure: medial pterygoid muscle
  • posterior structure: parotid gland and facial nerve
  • anterior structure: buccinator
  • superior structure: lateral pterygoid muscle
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15
Q

Which muscles does the needle pass through for IAN block?

A
  • Needle ONLY in buccinator muscle
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16
Q

What happens if you inject too far posteriorly into the mandible bypassing the target area ? what is the consequence?

A
  • possible injection into parotid gland
  • facial nerve is located here so would result in facial nerve paralyses (Bell’s palsy) - causing drooping of muscles of facial expression on injected side of the face.
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17
Q

Which nerves are anaesthetised when doing IAN block?

A
  • IAN therefore also will affect mental and incisive nerve
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18
Q

How do you identify successful IAN block clinically?

A
  • numb lower lip on associated side
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19
Q

What needle do we use for IAN block and why?

A
  • long needle (35mm), if using short needle - risk of needle breaking as you will inject all the way to the hub to get to right place.
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20
Q

Which anaesthetic do we use for IAN block?

A

Lidocaine

21
Q

why don’t we use articaine for IAN block?

A
  • more negative impact on nerve trunk
22
Q

how do you identify injection site for IAN block?

A
  1. ask patient to open wide to identify the ptergomandibular raphe - bot obvious in all pt.
  2. Place your thump in coronoid notch of anterior border of ramus inside the mouth, place your index finger on the posterior border of ramps outside the mouth - for support and helps you know where needle is.
  3. identify vertical height as half way up your thump/ roughly 1cm above the mandibular occlusal plane
  4. the injection site should be lateral to pterygomandibular raphe.

Final site: 1cm above occlusal plane and lateral to pterygomandibular raphe

23
Q

What is the angle of insertion for IAN block?

A
  • approach from the opposite side at the pre-molars
24
Q

When using long needle to deliver IAN block, how much of the needle should be inside?

A
  • 2/3rd of long needle ( length of needle is 3.5cm so approx. 2.5cm of needle should be in)
25
Q

What is the reason the needle is too far in? how do you solve this?

A
  • Injected too far and passed the posterior border of mandible
  • withdraw needle slightly, move towards the opposite side and deposit - you must get a bony contact
26
Q

what is the reason if the needle isn’t going in to the point it should? what do you do to fix this case?

A
  • The needle has hit the bone prematurely

- move needle towards the same side as injection, go deeper, aspirate then deposit

27
Q

What must you always do before deposition the LA?

A
  • Aspirate
28
Q

How much of the anaesthetic in cartridge (2.2ml) do we inject for IAN block?

A
  • inject approx half to a full cartridge

- should inject very slowly, must take approx. 2 mins

29
Q

What is the key sign that the IAN block has worked?

A

numb lower lip due to mental nerve being anaesthetised

30
Q

what does it mean if lips are tingling?

A
  • wait longer for anaesthetic to work
31
Q

when doing IAN block, which teeth are numbed?

A
  • all the lower teeth on the side injected, with some overlap of the other side ( 2 incisors on other side)
32
Q

How do you carry out lingual nerve block?

A
  • same landmarks as IANB, same technique
  • difference: needle more superficial
    • Needle only about 1cm in (approx. 1.5cm more superficial than IANB)
33
Q

How can you perform IANB and lingual nerve block at once?

A
  • perform IANB

- withdraw needle by 1.5cm, aspirate, inject remaining of cartridge.

34
Q

how can you identify successful lingual nerve block?

A
  • ipsilateral numb tongue (on same side as injection)
35
Q

Why do you do long buccal nerve block?

A
  • to anaesthetise soft tissues adjacent to mandibular molars
36
Q

Identify the landmarks for delivering long buccal nerve block.

A
  • Find the coronoid notch
  • Aim for the buccal aspect of coronoid notch
  • injects almost immediately into mandibular bone
37
Q

what needle do you use for lingual nerve block?

A
  • long needle or short needle (optional)
38
Q

Where do we aim for to delivery Mental/incisive nerve block?

A
  • aim for mental foramen directly
39
Q

which teeth and mucosa do we anaesthetise doing mental/ incisive nerve block?

A
  • mental nerve block - anaesthetises labial/buccal mucosa
  • incisive nerve block - 1st pre-molar to lateral incisors on the same side (lateral incisor, canine and first pre molar)
40
Q

how do you locate mental foramen to delivery mental/incisive nerve block?

A
  • the mental foramen is inferior and in between the apexes of first and second premolar
41
Q

Why should we consider mandibular infiltrations for lower incisors?

A
  • block anaesthesia not reliable due to crossover
42
Q

Why is infiltration of incisors possible in the mandible?

A
  • thinner bone around incisors so anaesthetic can diffuse through to reach pulp
43
Q

Why shouldn’t you infiltrate only buccally for lower incisors?

A
  • only 50% success rate
44
Q

how should you do a lower incisor infiltration?

A
  • split dose: 0.5ml buccally, 0.5ml lingually - increases success to 90%
45
Q

How do you inject buccal infiltration for lower incisors?

A
  • same as maxillary infiltration
46
Q

How do you inject lingual infiltration for lower incisors? why is it more awkward?

A
  • inject in reflected mucosa near tooth apex
  • do lingual infiltration 8-10 mins before pulpal anaesthesia is needed
  • more difficult because lingual surface of mandible slopes away from you
47
Q

why should you do lingual infiltration 8/10 mins before needing pulpal anaesthesia?

A
  • thicker cortical bone lingually so solution takes longer to diffuse
48
Q

Why is lower molar infiltrations a good alternative to IANB?

A
  • for safety
49
Q

is 4% articaine more effective for nerve block than 2% lidocaine?

A
  • most papers show similar efficacy

- some show slight more efficacy with 4% articaine

Module 3: Local anaesthesia (5 decks)

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