Mandibular Injection Techniques Flashcards
proper hand position with the syringe?
palm down = poor control
palm up = better control
palm up and finger rest = BEST CONTROL
two soft tissue injections with mandibular anesthesia?
Mental
Buccal
4 mandibular block anesthesia
- IANB
- Incisive
- Gow-gates
- Vazirini - Alkinosis (closed mouth)
metal aesthesia is strictly what?
SOFT TISSUE
#32 extraction with soft tissue flap, removal of bone, and sectioning tooth? Which LA technique to obtain adequate LA?
- IANB with long buccal
- Gow-gates
- Vazirini- akinosi
three techniques you can use to take out a wisdom tooth?
- IANB with long buccal
- Gow-gates
- Vazirini- akinosi
nerves anesthetized in an IANB?
- incisive
- mental
lingual is common
areas anesthetized in an IANB?
Mandibular teeth up to the midline
body of mandible, inferior part of the ramus
buccal mucoperiosteum, mucous membranes ANTERIOR to the mental foraemen (via mental nerve)
anterior 2/3 of the tongue and floor of oral cavity – lingual nerve
indication for giving an IANB
- procedures on multiple mandibular teeth
- when buccal soft tissue anesthesia is required anterior to the mental foramen
- when lingual soft tissue anesthesia is required
if pt. cannot open their mouth what can you not do?
Full IANB technique
- likely due to trismus
contraindications for IANB
- infection or actute inflammation in the area of the injection
- patients who might bite lips or tongue (very young child, handicaped patient)
- limitation to mouth opening *
Landmaks for preforming IANB?
- cornoid notch
- pterygomandibular raphe
- the occlusal plane of mandibular teeth
- contralateral premolars
position where you sit when giving an IANB on right side? left side?
right side = face patient and sit 8 oclock
left side - face same direction (face the patient) but sit at 10 oclock
pt. develops right sided facial paralysis. what happened?
facial nerve gets anesthetized
– needle goes beyond posterior border of the mandible into parotid
facial nerve controls muscles of the eye?
YES – so cant close the eye
opens the eye?
CN III
innervates LPS
CN VII action on eye and what it innervates
Innervates obicularis oris and is repsonsible for opening the eye
what happens if needle goes too deep in IANB?
could go into the parotid bed where cranial nerve 7 is and facial nerve paralysis
bone contact with IANB?
want to make sure we do not go too deep and into parotid bed– so if no contact likely had overinsertion and so you need to RETRACT AND REPOSITION LATERALLY
if you do not get adequate LA with an IANB what is likely the cause?
- too low (MOST COMMON)
- injection too far anterior
- ACCESSORY INNERVATION –
how to correct for accessory innervation in an IANB?
correct by
- lingual infiltrate
- PDL
- Inject lower for a bifid IAN
technique that has highest incidence of aspiration?
IANB (10-15%)
what is not anesthetized with an Incisve nerve block
the lingual soft tissues
incisive nerve block - explain general
Terminal branch of the IAN
Travels in the incisve canal as a terminal branch of the IAN
(always anaesthetized with a successful IANB) – but this technique will not anesthetize the lingual soft tissue
incisive nerve block contraindication
infection or acute inflammation in the area of injection
advantages of the incisive nerve block
provides pulpal anesthesia without lingual anesethsia (could also be seen as a disadvanatge)
after successful IAN block - make your soft tissue incision and the patient feels pain, what happened?
forgot to anesthetize the long buccal nerve
what do you have to give with an IAN block when taking out a 3rd molar?
LONG BUCCAL NERVE BLOCK
- soft tissues and periosteium buccal tot he mandibular molar teeth
areas anesthetized with a buccal nerve block? what type is this? when is it used?
usually with a IANB when taking out 3rd molars
is soft tissue – basically up to first molar
soft tissues and periosteium buccal tot he mandibular molar teeth
indications for a buccal nerve block?
when buccal soft tissue anesthesia is required for dental procedures in the mandibular molar region
contraindications for buccal nerve block
infection or acute inflammation in the area of injection
advantages to buccal nerve block
high success rate
technically easier
disadvantages for buccal nerve block
potential for pain if the needle contacts the periosteum
which is a ‘true’ mandibular nerve block?
Gow-gates
nerves anesthetized in a gow-gates block?
7 total
- inferior alveolar
- lingual
- mylohyoid
- mental
- incisive
- auriculotemporal
- buccal (in 75% of pt’s)
indications for gow-gates
similar to the IAN
- need multiple procedures on mandibular teeth
- conventional inferior alveolar nerve block is unsuccessful
- lingual soft tissue anesthetic is needed
- buccal soft tissue anesthesia needed from the third molar to the midline
difference in areas anesthetized with IANB vs. Gow gates
skin over the zygoma, posterior portion of the cheek, and temporal region can be anesthetized in the gow-gates method via the auriculotemporal nerve **
landmarks for Gow-gates
- mucous membrane on mesial of the ramus
- line from the intertragic notch to the corner of the mouth
- target area = condylar neck just below the insertion of the lateral pterygoid muscle
- height = just below the maxillary ML cusp of the 2nd molar
- site = penetrate just distal to the maxillary 2nd molar
area of insertion for gow-gates
mucous membrane on mesial of the ramus
target area for gow-gates
condylar neck just below the insertion of the lateral pterygoid muscle
site of pentration in gow-gates
just distal to the maxillary 2nd molar
contraindications for gow-gates
- infection or acute inflammation in the area of injection
- patients who might bite their lip or tongue
- patietns who are unable to open their mouth wide
advantages of gow-gate
requires only one injection (vs. IANB with the long buccal)
- provides succesful anesthesia where a bifid IAN and bifid manibular canals are present
epidural hematoma from what?
tearing middle meningeal artery if fracture the pterion of skull
how could solution gain access to the cavernous sinus?
with reference to Gow-gates block
origins of the middle meningeal and inferior alveolar arteris are in close porximity to each other
-so by way of the arterial system, solution may gain access to the cavernous sinus
*** middle meningeal and inferior alveolar aeteries – so by way of arterial system if the LA soliution gets into these arteries
temporary paralysis of CN III, IV, VI?
with reference to Gow-gates block
origins of the middle meningeal and inferior alveolar arteris are in close porximity to each other
-so by way of the arterial system, solution may gain access to the cavernous sinus
complications of Goq-gates
hematoma
trismus - rate
temporary paralysis of CN III, IV, VI
a pt. cannot open their mouth - which local anesthetic technique would you perform?
Vazirani-akinosi closed mouth block
Vazirani-akinosi block - which nerves anesthetized?
Inferior alveolar incisive mental lingual mylohyoid
areas anesthetized with Vazirani-akinosi closed mouth block
mandibular teeth to midline
body of the mandible and inferior portion of the ramus
buccal mucoperiosteum and mucous membrane in front of the mental foramen
anterior 2/3 of the tongue an the floor of the mouth
lingual soft tissue and periosteum
indications to perform Vazirani-akinosi closed mouth block
- limited ability in mandibualr opening
2 .inability to visualize the IANB landmarks
contraindications to Vazirani-akinosi closed mouth block
- infection, acute inflammation
- patients who might bite themselves
- inability to visualize or gain access to lingual aspect of the ramus
area of insertion for Vazirani-akinosi closed mouth block
- MANDIBULAR MEDIAL SOFT TISSUE
- adjacent to maxillary tuberosity
- height of muco-gingival junction adjacent to 3rd molar
disadvanatges to Vazirani-akinosi closed mouth block
difficult to visualize the path of the needle and the depth of insertion
no bony contact; depth of penetration somewhat arbitrary
potentially traumatic if needle is too close to periosteum
indication for mental nerve block
soft tissue biopsies and sutering
area anesthetized in mental nerve block
buccal mucous membrane anterior to the mental foramen to the midline and the skin of the lower lip
triangulate what 3 hard tissue landmarks for IANB? what is at the center?
- coronoid notch
- mandibular angle
- posterior condyle
center = approx. location of the mandibular foramen
triangulate what 3 soft tissue landmarks for IANB? what is at the center?
- buccal tissues on mandible
- lateral pterygoid
- PMR - medial pterygoid
center= approx. location of the mandibular foramen
