Mandibular Anesthesia Flashcards
What nerve provides pulpal innervation to the mandibular molars and premolars?
Inferior alveolar nerve.
What nerve provides pulpal innervation to the incisors and canines?
Incisive nerve
What does the mental nerve supply?
Buccal mucosal innervation to mandibular incisors, canines and premolars
What nerve provides mucosal innervation to the molars buccally?
Long buccal nerve.
What nerve provides mandibular lingual soft tissue innervation?
Lingual nerve
What are 2 names for the IANB technique used?
Halstead approach/ direct technique.
What is in front of the mandibular foramen and may cause trouble when providing IANB?
Lingula
What space are we injecting into in an IANB?
Pterygomandibular space.
What are the boundaries (5) of the pterygomandibular space?
- Lateral: ramus
- Medial: medial pterygoid.
- Posterior: Parotid and facial nerve.
- Anterior: buccinator
- Superior: lateral pterygoid
What is important about the posterior border of the pterygomandibular space during IANB?
- The pterygomandibular space is bordered posteriorly by the parotid gland and its capsule which contains the facial nerve. If you deposit anesthetic solution too far posterior and into that capsule you can affect the facial nerve (which includes the motor function). This can cause drooping of the muscles of facial expression on that side.
What happens if you inject anesthetic into the facial nerve during IANB?
DROOPING OF THE MUSCLES OF FACIAL EXPRESSION ON THAT SIDE.
What is a sign that IANB has worked? What has it anesthetized?
NUMB LOWER LIP on the side.
HAs anesthetizes IAN and everything downstream it including MENTAL NERVE.
What anatomical structure can be a barrier to an effective IANB?
sphenomandibular ligament
What landmarks do we use during IANB?
Pterygomandibular raphe
Thumb on coronoid notch/ external oblique ridge/ ascending ramus
What are the attachments of the pterygomandibular raphe?
this goes from the PTERYGOID HAMULUS superiorly which is medial to the maxillary tuberosity or the last molar) and comes down just on the lingual side of the mandible.
Why do we go halfway up our thumbnail in IANB?
halfway up your thumbnail (roughly a centimeter above the occlusal plane, hence we are putting the needle in about 1cm above the mandibular foramen, making it more likely that we will catch that nerve before it enters the foramen
What other nerve can be anesthetize when giving IANB? How?
Give IANB, WITHDRAW NEEDLE 1-1.5CM then GIVE REMAINING OF CARTRIDGE TO ANESTHETIZE THE LINGUAL NERVE.
Buccal nerve block?
- The long buccal nerve is located much more superiorly to the lingual and inferior alveolar nerves and runs into the buccal mucosa.
- Inject towards the lateral border of the ramus of the mandible, across the third molar.
What needle is used for buccal nerve block?
- Only need SHORT NEEDLE as not going into a space/ hitting bone right away.
How is a mental nerve block done? What needle is used?
Inject between the apices of the lower 4 and 5.
SHORT NEEDLE.
How are lower incisors anesthetized most reliably?
- Block not reliable due to CROSSOVER.
- Only B or L –> 50% success rate.
- Split dose (B and L) –> 90% success.
SPLITTING DOSE AFFECTS SUCCESS RATE.
