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Intro to OS and Pain Management > Mandibular Injection Techniques > Flashcards

Mandibular Injection Techniques Flashcards

1
Q

where is the buccal nerve located

A

between lateral pterygoid heads

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2
Q

what does the buccal nerve supply sensory innervation to

A
  • cheek area
  • molar buccal gingiva
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3
Q

what type of needle is used with buccal nerve block

A

25 gauge long needle

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4
Q

what are the steps to the buccal nerve block

A
  • stretch tissue
  • contact periosteum
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5
Q

what tissues are anesthetized in the buccal nerve block

A
  • gingiva buccal to molars
  • retromolar pad mucosa
  • buccal mucosa in molar area
  • no hard tissues anesthetized
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6
Q

when is the buccal nerve block indicated

A

when buccal soft tissue anesthesia is required

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7
Q

what are the advantages of the buccal nerve block

A
  • high success rate
  • easy injection to administer
  • atraumatic
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8
Q

what is the posterior division of the mandibular nerve

A
  • primarily sensory
  • auriculotemporal nerve
  • lingual nerve
  • inferior alveolar nerve
  • mylohyoid nerve
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9
Q

what areas are innervated by the auriculotemporal nerve

A
  • 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
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10
Q

the lingual nerve is the ______ of the posterior division

A

second branch

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11
Q

what does the lingual nerve innervate

A

-the anterior 2/3 of tongue
-lingual mucosa

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12
Q

what is the lingual nerve blocked with

A
  • inferior alveolar block
  • mandibular block
  • gow-gates mandibular block
  • vazirana akinosi block
  • infiltration in lingual sulcus
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13
Q

what is the largest branch of the posterior division

A

inferior alveolar nerve

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14
Q

what ligament is associated with the inferior alveolar nerve

A

sphenomandibular ligament

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15
Q

what does the inferior alveolar nerve exit through

A

the mandibular foramen

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16
Q

the mandibular foramen is at the level of:

A

the coronoid notch

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17
Q

where do you inject for inferior alveolar nerve block

A
  • at level of coronoid notch
  • directed across arch
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18
Q

what muscle does the syringe penetrate for the inferior alveolar nerve block

A

buccinator

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19
Q

inferior alveolar nerve block penetration lateral to:

A

pterygomandibular raphe

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20
Q

where do you inject for the inferior alveolar nerve block

A

between raphe and notch

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21
Q

what are the steps for inferior alveolar nerve block

A
  • 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
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22
Q

what nerves are anesthetized with the inferior alveolar nerve block

A
  • inferior alveolar
  • incisive
  • mental
  • lingual
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23
Q

when is the inferior alveolar nerve block indicated

A
  • wide area requires anesthesia
  • buccal tissue anesthesia is needed
  • lingual soft tissue anesthesia is needed
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24
Q

when is the inferior alveolar nerve block contraindicated

A
  • infection in area
  • acute inflammation in area
  • patient a potential lip biter
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25
Q

what are the advatnages to the inferior alveolar nerve block

A
  • provides wide area of anesthesia
  • minimizes anesthetic dose
26
Q

what are the disadvantages to the inferior alveolar nerve block

A
  • wide area anesthetized
  • unsuccessful in 15-20%
  • inconsistent oral landmarks
    -10-15% positive aspiration
27
Q

what are the alternatives to the inferior alveolar nerve block

A
  • mental nerve block
  • incisive nerve block
  • gow-gates block
  • vazirani-akinosi block
  • intraosseous or intraseptal injection
28
Q

the mental nerve is the ____ of the inferior alveolar nerve

A

terminal branch

29
Q

what are the steps to the mental nerve block

A
  • 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
30
Q

what areas are anesthetized with the mental nerve block

A
  • mucosa anterior to foramen
  • skin of the lower lip
  • chin
31
Q

what are the indications for the mental nerve block

A
  • soft tissue anesthesia
  • suturing lip lacerations
  • biospies of lip tissue
32
Q

what are the contraindications for the mental nerve block

A
  • infection in the area
  • acute inflammation
33
Q

what are the advantages to the mental nerve block

A
  • high success rate
  • technically easy
  • usually entirely atraumatic
34
Q

what are the disadvantages to the mental nerve block

A
  • hematoma
  • positive aspiration 5.7%
35
Q

incisive nerve is ____ of inferior alveolar nerve

A

terminal branch

36
Q

what does the incisive nerve supply

A

incisors, canine, premolars

37
Q

what are the steps for the incisive nerve block

A
  • identical to mental block with pressure maintained 2 minutes
  • trans papilla injection for lingual anesthesia
38
Q

what areas are anesthetized with the incisive nerve block

A
  • mucosa on buccal
  • lower lip
  • skin of the chin
  • premolars, canines, incisors
39
Q

what are the indications for the incisive nerve block

A
  • procedures on anterior teeth
  • when inferior alveolar block is not indicated
  • to avoid bilateral mandibular blocks
40
Q

what are the contraindications to the incisive nerve block

A
  • infection
  • acute inflammation
41
Q

what are the advantages for the incisive nerve block

A
  • provides pulpal and hard tissue anesthesia without lingual anesthesia
  • high success rate
42
Q

what are the disadvantages to the incisive nerve block

A
  • no lingual anesthesia
  • may be sensory overlap at midline (rare)
  • positive aspiration 5.7%
43
Q

what is the Gow-Gates nerve block

A
  • true mandibular nerve block
44
Q

what does the needle contact in the gow gates nerve block

A

the neck of condyle

45
Q

what are the 2 extra oral landmarks for the gow gates nerve block

A
  • corner of mouth
  • intertragic notch
46
Q

the needle puncture in the gow gates nerve block is dictated by:

A

intra oral landmarks

47
Q

what are the steps to the gow gates nerve block

A
  • pt opens wide and the condyle moves forward
  • advance until bone contacted
  • withdraw 1mm, aspirate, inject 1.8mL
48
Q

what nerves are anesthetized with the gow gates nerve block

A
  • inferior alveolar
  • lingual
  • mylohyoid
    -auriculotemporal
  • buccal (in75%)
49
Q

when is the gow gates nerve block indicated

A
  • multiple procedures
  • buccal anesthesia required
  • lingual anesthesia required
  • minimal dose of anesthetic
50
Q

what are the contraindications for the gow gates nerve block

A
  • infection in area
  • inflammation in area
  • potential lip biter
  • restricted mouth opening
51
Q

what are the advantages to the gow gates nerve block

A
  • 95-99% success rate
  • single injection
  • minimal aspiration rate
  • few complications
  • blocks mylohyoid nerve
52
Q

what are the disadvantages to the gow gates nerve block

A
  • 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
53
Q

what is another name for the vazirani-akinosi nerve block

A

closed mouth

54
Q

what is the height of injection for the vazirani-akinosi nerve block

A
  • maxillary muco gingival line
55
Q

vazirani-akinosi nerve block is ____ to ramus

A

directly parallel

56
Q

what are the steps to the vazirani akinosi nerve block

A
  • insert to 25mm depth
  • aspirate, inject 1.5 to 1.8mL
57
Q

what nerves are anesthetized with the vazirani akinosi nerve block

A
  • inferior alveolar
  • lingual
  • mylohyoid
58
Q

what are the indications for the vazirani akinosi nerve block

A
  • limited mouth opening
  • multiple procedures planned
  • landmarks poorly visible for other injections
59
Q

when is vazirani akinosi nerve block contraindicated

A
  • infection in area
  • inflammation in area
  • potential lip biter
  • inadequate access
60
Q

what are the advantages to the vazirani akinosi nerve block

A
  • relatively atraumatic
  • no need to open mouth
  • aspiration rate less than 10%
  • high success rate
  • relatively simple
  • blocks mylohyoid nerve
61
Q

what are the disadvantages to the vazirani akinosi nerve block

A
  • difficult visualization
  • no bony contact
  • arbitrary insertion depth
  • variable buccal nerve anesthesia
  • improper angulation may lead to maxillary anesthesia
62
Q
A

Intro to OS and Pain Management (9 decks)

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