MANDIBULAR ANESTHESIA Flashcards
What are the branches of V3
undivided and divided nerve
what are the nerves under the undivided nerve
nerve to medial pterygoid muscle aka interior pterygoid muscle
motor nerve
In four branches of the anterior division, what muscles that has motor nerve
masseter, temporalis,external pterygoid or the lateral pterygoid muscle
what nerve that has sensation and it is innervate the buccal mucosa and buccal gingiva in the molar area
long buccal nerve
what are the 4 branches of anterior division?
nerve to masseter
nerve to temporalis
nerve to lateral pterygoid or the external pterygoid
long buccal nerve
what are the branches of posterior division
inferior alveolar nerve
lingual nerve
mylohyoid nerve
auriculotemporal nerve
it will go down and enter the bone
inferior alveolar nerve
it will go lingually, outside the bone and towards the tongue
lingual nerve
it will go down to the floor of the mouth and serves as motor nerve
mylohyoid nerve
it will go up to the ear
auriculotemporal nerve
positioned lingual side of the bone
mandibular foramen
positioned in the buccal side of the bone
mental foramen
branch of IAN, goes anteriorly to the bone going to the midline
incisive nerve
will go up to the mental foramen and its outside the bone and innervated only the soft tissue
mental nerve
after it enters in the mandibular foramen, it will give off the branches to supply the pulp tissue of the molars
inferior alveolar nerve
as it continues anteriorly, what tissues did the incisive nerve innervates
pulp tissue of the premolar, canine and incisors
what nerve will exit the foramen, running to the lip, labial mucosa, chin and submental area
mental nerve
after the mental nerve, it will go to tongue area
lingual nerve
part of the posterior division that only innervates the soft tissue
mental and lingual nerve
dental plexus of the mandible
inferior alveolar nerve and incisive nerve
most important and most frustrating technique in dentistry
IAN nerve block
what nerves anesthesize by the IAN block?
IAN, mental, incisive and lingual nerve
what are the indications of IANB?
procedures on multiple mandibular teeth.
buccal soft tissue and lingual soft tissue anesthesia is necessary
what are the contraindications of IANB?
infection or acute inflammation in the area of injection.
patients who might bit their lip or tongue.
objective of IANB?
direct the needle into the pterygomandibular space as close to the IAN so that the local anesthesia deposited in close proximity to the nerve.
what are the anatomic boundaries of pterygomandibular space anteriorly? posteriorly? superiorly? inferiorly? medially? laterally?
anterior: posterior border of the buccal plate
posterior: parotid gland
superior: lateral pterygoid muscle
inferior: inferior border of the mandible
medial: medial pterygoid muscle
lateral: ascending ramus of the mandible
what significant landmarks where the bone stop?
ascending ramus of the mandible
contents of pterygomandibular space
third division of trigeminal nerve
inferior alveolar nerve
sphenomandibular ligament
what happen to sensory and motor nerve when unwanted effect happen?
sensory nerve produce paresthesia
motor nerve will paralyzed
what is the target when we do the IANB?
slightly superior to the mandibular foramen at the height of coronoid notch
where is the coronoid notch located?
at the depression in the anterior ascending ramus
what is the height of injection in IANB?
6-10mm of coronoid notch
anteriorposterior distance of syringe from the coronoid notch to the part of pterygomandibular raphe?
3/4
anterior landmark in IANB
coronoid notch
posterior landmark and deepest part where the line “ > “ turns upwards
pterygomandibular raphe
the needle should be _______ to the occlusal plane, opposite the premolars
parallel
what if you contacted the bone, but the needle inserted is only 1/4?
reposition the syringe,retract a little and move the barrel of the syringe anteriorly
what if you inserted the full length of the syringe without any contact of the bone
retract the needle halfway then move the syringe posteriorly and insert it again
how much is the anesthesia deposit in direct technique of IANB?
deposit 1.5 ml of solution while contact with the bone then withdraw the halfway of the needle, still the same position and deposit 0.1-0.2 ml of solution again
or deposit 1.7ml of solution entirely to the initial position where the needle is in contact
how is the indirect technique of IANB?
deposit 1.5ml of solution while in contact with the bone then withdraw the needle halfway and swing it on the other side towards the cheeks
what nerve anesthesize in second deposit of the LA in IANB?
for the lingual nerve
a very shallow injection technique, you will contact the bone immediately
long buccal nerve
where is the long needle to insert during long buccal nerve technique?
buccal and distal to the last molar
success rate of IANB?
80-85%
6 failure during IANB technique
greater density of the buccal alveolar plate
limited accessibilityto the inferior alveolar nerve
wide variation in anatomy
deposition of anesthetic is too low below the mandibular foramen
deposition is too far anteriorly on the ramus
accessory innervation to the mandibular teeth
in children, how many degrees is suggested for the syringe is inclined in anteroposterior direction with the occlusal plane
5 degrees
what are the anatomical variations
accessory mylohyoid nerve
bifid mandibular nerve
prescence of retromolar foramen
contralateral innervation of the anterior teeth
what type of anesthesia is used when the patient feels pain intraoperatively
intraligamentary and intrapulpal
a mandibular nerve block that has sensory and motor that is supplemental injection to IANB?
mylohyoid nerve block
what innervated by the mylohyoid nerve sensory and motor?
sensory- pulp of mandibular teeth
motor- mylohyoid muscle and anterior belly of digastric muscle
how many ml deposit during mylohyoid nerve block
0.6 ml
theres a large foramen then bifurcates, could be unilateral and bilateral
type 1
a large foramen then it bifurcates then fuse again, could it limited to ramus or extend to body of ramus
type 2 bifid IAN
combination of type 1 and 2
type 3 bifid IAN
has two mandibular foramen and difficult to anesthesize
type 4 bifid IAN
significance of retromolar foramen in oral surgery when has impacted teeth
you can encounter bleeding intraoperatively because of the blood vessel present in the canal
this technique is suggested in patient that has blood dyscrasias
IAN via retromolar triangle
how many mm is the needle inserted by IAN via retromolar triangle from the distal face of the last molar
5mm
what foramen is commonly mistaken pathology because it is located in apex of the second premolar
mental foramen
along the vertical how many mm is the mental nerve block inserted from the inferior border of the mandible
7mm
along the vertical line of the mental foramen during mental nerve block, how many mm from the CEJ of the 2nd premolar?
15mm
what is the area of insertion and ml of solution in mental nerve block
insert in mucobuccal fold anteriorly to mental foramen
0.6ml
similar to mental nerve block but you have to massage it where you inject for 2 mins
incisive nerve block
incisive nerve block anesthesize the?
premolars, canine and incisors
why there’s a chance of post injection pain in IANB when repeating the block
because of pterygomandibular space that can only accomodate up to 5ml of solution
insert the needle in the sulcus of the tooth
intraligamentary injection
only if there’s a pulpal exposure and it is very painful technique
intra pulpal
what supplemental injection that is contraindicated in pediatric patients because the developing teeth may be puncture or injure and also contraindicated for the patients that has hypertension
intrasseous injection
for the limited mouth opening inserting in maxillary tuberosity and ramus
akinosi closed mouth technique
a true mandibular technique
gow gates technique
area of insertion and ml of solution in gow gates technique
distal to the maxillary second molar at the height of the mesiolingual cusp
1.8-3 ml
extraoral landmarks of gow gates technique
at the corner of the mouth to the tragus of the ear
what is the target area of gow gates technique
neck of the condyle
what nerve anesthesize by the gow gates
IAN
incisive
lingual
mental
long buccal nerve
mylohyiod nerve
auriculotemporal nerve
how many success rates by the conventional IANB, gow gates and akinosi technique?
IANB- 80-85%
gow gates- 95%
akinosi- 93%
Needle used in adult and child
Adult: 2/3-3/4 long needle
Child: 3/4 of short needle
How to utilize the prescence of the retromolar foramen
Another opening of mandibular canal
It allows the innervation of the incisors on the contralateral side.
Midline crossover of branches of the mental nerves in the mandible
A technique to correct partial anesthesia in lower incisor areas caused by overlap of sensory fibers from the contralateral side
Infiltration or supraperiosteal
A technique when isolated portions of mandibular teeth, usually the mesial root of mandibular first molar
PDL injection
A supplemental technqiue when IANB is not effective primarily the tooth is pulpally involved
Intraosseous anesthesia
A positive aspiration in gow gates is occurs in ?
Internal maxillary artery
