Mandibular Injection Techniques Flashcards
where is the buccal nerve located
between lateral pterygoid heads
what does the buccal nerve supply sensory innervation to
- cheek area
- molar buccal gingiva
what type of needle is used with buccal nerve block
25 gauge long needle
what are the steps to the buccal nerve block
- stretch tissue
- contact periosteum
what tissues are anesthetized in the buccal nerve block
- gingiva buccal to molars
- retromolar pad mucosa
- buccal mucosa in molar area
- no hard tissues anesthetized
when is the buccal nerve block indicated
when buccal soft tissue anesthesia is required
what are the advantages of the buccal nerve block
- high success rate
- easy injection to administer
- atraumatic
what is the posterior division of the mandibular nerve
- primarily sensory
- auriculotemporal nerve
- lingual nerve
- inferior alveolar nerve
- mylohyoid nerve
what areas are innervated by the auriculotemporal nerve
- skin over areas suppled by VII
- skin over helix and tragus of ear
- skin of external auditory meatus
- posterior part of TMJ
- skin over temporal area
the lingual nerve is the ______ of the posterior division
second branch
what does the lingual nerve innervate
-the anterior 2/3 of tongue
-lingual mucosa
what is the lingual nerve blocked with
- inferior alveolar block
- mandibular block
- gow-gates mandibular block
- vazirana akinosi block
- infiltration in lingual sulcus
what is the largest branch of the posterior division
inferior alveolar nerve
what ligament is associated with the inferior alveolar nerve
sphenomandibular ligament
what does the inferior alveolar nerve exit through
the mandibular foramen
the mandibular foramen is at the level of:
the coronoid notch
where do you inject for inferior alveolar nerve block
- at level of coronoid notch
- directed across arch
what muscle does the syringe penetrate for the inferior alveolar nerve block
buccinator
inferior alveolar nerve block penetration lateral to:
pterygomandibular raphe
where do you inject for the inferior alveolar nerve block
between raphe and notch
what are the steps for inferior alveolar nerve block
- dry the site
- apply topical anesthetic
-wait one-two minutes
-finger on notch to retract cheek and determine height of injection - aspirate, inject 1.5mL over 60 sec
- insert ~25mm to contact bone
- withdraw halfway, deposit 0.1mL at lingual nerve
what nerves are anesthetized with the inferior alveolar nerve block
- inferior alveolar
- incisive
- mental
- lingual
when is the inferior alveolar nerve block indicated
- wide area requires anesthesia
- buccal tissue anesthesia is needed
- lingual soft tissue anesthesia is needed
when is the inferior alveolar nerve block contraindicated
- infection in area
- acute inflammation in area
- patient a potential lip biter
what are the advatnages to the inferior alveolar nerve block
- provides wide area of anesthesia
- minimizes anesthetic dose
what are the disadvantages to the inferior alveolar nerve block
- wide area anesthetized
- unsuccessful in 15-20%
- inconsistent oral landmarks
-10-15% positive aspiration
what are the alternatives to the inferior alveolar nerve block
- mental nerve block
- incisive nerve block
- gow-gates block
- vazirani-akinosi block
- intraosseous or intraseptal injection
the mental nerve is the ____ of the inferior alveolar nerve
terminal branch
what are the steps to the mental nerve block
- palpate the mental foramen
- determine site of injection
- dry the area and apply topical
- orient needle bevel facing bone
- insert into tissue over foramen
- deposite 0.6mL over 20 seconds
what areas are anesthetized with the mental nerve block
- mucosa anterior to foramen
- skin of the lower lip
- chin
what are the indications for the mental nerve block
- soft tissue anesthesia
- suturing lip lacerations
- biospies of lip tissue
what are the contraindications for the mental nerve block
- infection in the area
- acute inflammation
what are the advantages to the mental nerve block
- high success rate
- technically easy
- usually entirely atraumatic
what are the disadvantages to the mental nerve block
- hematoma
- positive aspiration 5.7%
incisive nerve is ____ of inferior alveolar nerve
terminal branch
what does the incisive nerve supply
incisors, canine, premolars
what are the steps for the incisive nerve block
- identical to mental block with pressure maintained 2 minutes
- trans papilla injection for lingual anesthesia
what areas are anesthetized with the incisive nerve block
- mucosa on buccal
- lower lip
- skin of the chin
- premolars, canines, incisors
what are the indications for the incisive nerve block
- procedures on anterior teeth
- when inferior alveolar block is not indicated
- to avoid bilateral mandibular blocks
what are the contraindications to the incisive nerve block
- infection
- acute inflammation
what are the advantages for the incisive nerve block
- provides pulpal and hard tissue anesthesia without lingual anesthesia
- high success rate
what are the disadvantages to the incisive nerve block
- no lingual anesthesia
- may be sensory overlap at midline (rare)
- positive aspiration 5.7%
what is the Gow-Gates nerve block
- true mandibular nerve block
what does the needle contact in the gow gates nerve block
the neck of condyle
what are the 2 extra oral landmarks for the gow gates nerve block
- corner of mouth
- intertragic notch
the needle puncture in the gow gates nerve block is dictated by:
intra oral landmarks
what are the steps to the gow gates nerve block
- pt opens wide and the condyle moves forward
- advance until bone contacted
- withdraw 1mm, aspirate, inject 1.8mL
what nerves are anesthetized with the gow gates nerve block
- inferior alveolar
- lingual
- mylohyoid
-auriculotemporal - buccal (in75%)
when is the gow gates nerve block indicated
- multiple procedures
- buccal anesthesia required
- lingual anesthesia required
- minimal dose of anesthetic
what are the contraindications for the gow gates nerve block
- infection in area
- inflammation in area
- potential lip biter
- restricted mouth opening
what are the advantages to the gow gates nerve block
- 95-99% success rate
- single injection
- minimal aspiration rate
- few complications
- blocks mylohyoid nerve
what are the disadvantages to the gow gates nerve block
- longer onset >5 minutes
- no intraoral landmarks
- variable buccal nerve anesthesia
- requires patient to open mouth widely
- variable location of soft tissue landmarks
- requires visualization of both intraoral and extraoral soft tissue landmarks
what is another name for the vazirani-akinosi nerve block
closed mouth
what is the height of injection for the vazirani-akinosi nerve block
- maxillary muco gingival line
vazirani-akinosi nerve block is ____ to ramus
directly parallel
what are the steps to the vazirani akinosi nerve block
- insert to 25mm depth
- aspirate, inject 1.5 to 1.8mL
what nerves are anesthetized with the vazirani akinosi nerve block
- inferior alveolar
- lingual
- mylohyoid
what are the indications for the vazirani akinosi nerve block
- limited mouth opening
- multiple procedures planned
- landmarks poorly visible for other injections
when is vazirani akinosi nerve block contraindicated
- infection in area
- inflammation in area
- potential lip biter
- inadequate access
what are the advantages to the vazirani akinosi nerve block
- relatively atraumatic
- no need to open mouth
- aspiration rate less than 10%
- high success rate
- relatively simple
- blocks mylohyoid nerve
what are the disadvantages to the vazirani akinosi nerve block
- difficult visualization
- no bony contact
- arbitrary insertion depth
- variable buccal nerve anesthesia
- improper angulation may lead to maxillary anesthesia
