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ANES > MANDIBULAR ANESTHESIA > Flashcards

MANDIBULAR ANESTHESIA Flashcards

1
Q

What are the branches of V3

A

undivided and divided nerve

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2
Q

what are the nerves under the undivided nerve

A

nerve to medial pterygoid muscle aka interior pterygoid muscle
motor nerve

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3
Q

In four branches of the anterior division, what muscles that has motor nerve

A

masseter, temporalis,external pterygoid or the lateral pterygoid muscle

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4
Q

what nerve that has sensation and it is innervate the buccal mucosa and buccal gingiva in the molar area

A

long buccal nerve

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5
Q

what are the 4 branches of anterior division?

A

nerve to masseter
nerve to temporalis
nerve to lateral pterygoid or the external pterygoid
long buccal nerve

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6
Q

what are the branches of posterior division

A

inferior alveolar nerve
lingual nerve
mylohyoid nerve
auriculotemporal nerve

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7
Q

it will go down and enter the bone

A

inferior alveolar nerve

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8
Q

it will go lingually, outside the bone and towards the tongue

A

lingual nerve

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9
Q

it will go down to the floor of the mouth and serves as motor nerve

A

mylohyoid nerve

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10
Q

it will go up to the ear

A

auriculotemporal nerve

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11
Q

positioned lingual side of the bone

A

mandibular foramen

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12
Q

positioned in the buccal side of the bone

A

mental foramen

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13
Q

branch of IAN, goes anteriorly to the bone going to the midline

A

incisive nerve

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14
Q

will go up to the mental foramen and its outside the bone and innervated only the soft tissue

A

mental nerve

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15
Q

after it enters in the mandibular foramen, it will give off the branches to supply the pulp tissue of the molars

A

inferior alveolar nerve

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16
Q

as it continues anteriorly, what tissues did the incisive nerve innervates

A

pulp tissue of the premolar, canine and incisors

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17
Q

what nerve will exit the foramen, running to the lip, labial mucosa, chin and submental area

A

mental nerve

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18
Q

after the mental nerve, it will go to tongue area

A

lingual nerve

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19
Q

part of the posterior division that only innervates the soft tissue

A

mental and lingual nerve

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20
Q

dental plexus of the mandible

A

inferior alveolar nerve and incisive nerve

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21
Q

most important and most frustrating technique in dentistry

A

IAN nerve block

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22
Q

what nerves anesthesize by the IAN block?

A

IAN, mental, incisive and lingual nerve

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23
Q

what are the indications of IANB?

A

procedures on multiple mandibular teeth.
buccal soft tissue and lingual soft tissue anesthesia is necessary

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24
Q

what are the contraindications of IANB?

A

infection or acute inflammation in the area of injection.
patients who might bit their lip or tongue.

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25
Q

objective of IANB?

A

direct the needle into the pterygomandibular space as close to the IAN so that the local anesthesia deposited in close proximity to the nerve.

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26
Q

what are the anatomic boundaries of pterygomandibular space anteriorly? posteriorly? superiorly? inferiorly? medially? laterally?

A

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

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27
Q

what significant landmarks where the bone stop?

A

ascending ramus of the mandible

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28
Q

contents of pterygomandibular space

A

third division of trigeminal nerve
inferior alveolar nerve
sphenomandibular ligament

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29
Q

what happen to sensory and motor nerve when unwanted effect happen?

A

sensory nerve produce paresthesia
motor nerve will paralyzed

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30
Q

what is the target when we do the IANB?

A

slightly superior to the mandibular foramen at the height of coronoid notch

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31
Q

where is the coronoid notch located?

A

at the depression in the anterior ascending ramus

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32
Q

what is the height of injection in IANB?

A

6-10mm of coronoid notch

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33
Q

anteriorposterior distance of syringe from the coronoid notch to the part of pterygomandibular raphe?

A

3/4

34
Q

anterior landmark in IANB

A

coronoid notch

35
Q

posterior landmark and deepest part where the line “ > “ turns upwards

A

pterygomandibular raphe

36
Q

the needle should be _______ to the occlusal plane, opposite the premolars

A

parallel

37
Q

what if you contacted the bone, but the needle inserted is only 1/4?

A

reposition the syringe,retract a little and move the barrel of the syringe anteriorly

38
Q

what if you inserted the full length of the syringe without any contact of the bone

A

retract the needle halfway then move the syringe posteriorly and insert it again

39
Q

how much is the anesthesia deposit in direct technique of IANB?

A

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

40
Q

how is the indirect technique of IANB?

A

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

41
Q

what nerve anesthesize in second deposit of the LA in IANB?

A

for the lingual nerve

42
Q

a very shallow injection technique, you will contact the bone immediately

A

long buccal nerve

43
Q

where is the long needle to insert during long buccal nerve technique?

A

buccal and distal to the last molar

44
Q

success rate of IANB?

A

80-85%

45
Q

6 failure during IANB technique

A

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

46
Q

in children, how many degrees is suggested for the syringe is inclined in anteroposterior direction with the occlusal plane

A

5 degrees

47
Q

what are the anatomical variations

A

accessory mylohyoid nerve
bifid mandibular nerve
prescence of retromolar foramen
contralateral innervation of the anterior teeth

48
Q

what type of anesthesia is used when the patient feels pain intraoperatively

A

intraligamentary and intrapulpal

49
Q

a mandibular nerve block that has sensory and motor that is supplemental injection to IANB?

A

mylohyoid nerve block

50
Q

what innervated by the mylohyoid nerve sensory and motor?

A

sensory- pulp of mandibular teeth
motor- mylohyoid muscle and anterior belly of digastric muscle

51
Q

how many ml deposit during mylohyoid nerve block

A

0.6 ml

52
Q

theres a large foramen then bifurcates, could be unilateral and bilateral

A

type 1

53
Q

a large foramen then it bifurcates then fuse again, could it limited to ramus or extend to body of ramus

A

type 2 bifid IAN

54
Q

combination of type 1 and 2

A

type 3 bifid IAN

55
Q

has two mandibular foramen and difficult to anesthesize

A

type 4 bifid IAN

56
Q

significance of retromolar foramen in oral surgery when has impacted teeth

A

you can encounter bleeding intraoperatively because of the blood vessel present in the canal

57
Q

this technique is suggested in patient that has blood dyscrasias

A

IAN via retromolar triangle

58
Q

how many mm is the needle inserted by IAN via retromolar triangle from the distal face of the last molar

A

5mm

59
Q

what foramen is commonly mistaken pathology because it is located in apex of the second premolar

A

mental foramen

60
Q

along the vertical how many mm is the mental nerve block inserted from the inferior border of the mandible

A

7mm

61
Q

along the vertical line of the mental foramen during mental nerve block, how many mm from the CEJ of the 2nd premolar?

A

15mm

62
Q

what is the area of insertion and ml of solution in mental nerve block

A

insert in mucobuccal fold anteriorly to mental foramen
0.6ml

63
Q

similar to mental nerve block but you have to massage it where you inject for 2 mins

A

incisive nerve block

64
Q

incisive nerve block anesthesize the?

A

premolars, canine and incisors

65
Q

why there’s a chance of post injection pain in IANB when repeating the block

A

because of pterygomandibular space that can only accomodate up to 5ml of solution

66
Q

insert the needle in the sulcus of the tooth

A

intraligamentary injection

67
Q

only if there’s a pulpal exposure and it is very painful technique

A

intra pulpal

68
Q

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

A

intrasseous injection

69
Q

for the limited mouth opening inserting in maxillary tuberosity and ramus

A

akinosi closed mouth technique

70
Q

a true mandibular technique

A

gow gates technique

71
Q

area of insertion and ml of solution in gow gates technique

A

distal to the maxillary second molar at the height of the mesiolingual cusp
1.8-3 ml

72
Q

extraoral landmarks of gow gates technique

A

at the corner of the mouth to the tragus of the ear

73
Q

what is the target area of gow gates technique

A

neck of the condyle

74
Q

what nerve anesthesize by the gow gates

A

IAN
incisive
lingual
mental
long buccal nerve
mylohyiod nerve
auriculotemporal nerve

75
Q

how many success rates by the conventional IANB, gow gates and akinosi technique?

A

IANB- 80-85%
gow gates- 95%
akinosi- 93%

76
Q

Needle used in adult and child

A

Adult: 2/3-3/4 long needle
Child: 3/4 of short needle

77
Q

How to utilize the prescence of the retromolar foramen

A

Another opening of mandibular canal

78
Q

It allows the innervation of the incisors on the contralateral side.

A

Midline crossover of branches of the mental nerves in the mandible

79
Q

A technique to correct partial anesthesia in lower incisor areas caused by overlap of sensory fibers from the contralateral side

A

Infiltration or supraperiosteal

80
Q

A technique when isolated portions of mandibular teeth, usually the mesial root of mandibular first molar

A

PDL injection

81
Q

A supplemental technqiue when IANB is not effective primarily the tooth is pulpally involved

A

Intraosseous anesthesia

82
Q

A positive aspiration in gow gates is occurs in ?

A

Internal maxillary artery

ANES (7 decks)

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