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Pain Control > Mandibular Injection Techniques > Flashcards

Mandibular Injection Techniques Flashcards

1
Q

proper hand position with the syringe?

A

palm down = poor control

palm up = better control

palm up and finger rest = BEST CONTROL

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2
Q

two soft tissue injections with mandibular anesthesia?

A

Mental

Buccal

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3
Q

4 mandibular block anesthesia

A
  1. IANB
  2. Incisive
  3. Gow-gates
  4. Vazirini - Alkinosis (closed mouth)
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4
Q

metal aesthesia is strictly what?

A

SOFT TISSUE

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5
Q 
#32 extraction with soft tissue flap, removal of bone, and sectioning tooth? 
Which LA technique to obtain adequate LA?
A
  1. IANB with long buccal
  2. Gow-gates
  3. Vazirini- akinosi
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6
Q

three techniques you can use to take out a wisdom tooth?

A
  1. IANB with long buccal
  2. Gow-gates
  3. Vazirini- akinosi
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7
Q

nerves anesthetized in an IANB?

A
  1. incisive
  2. mental

lingual is common

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8
Q

areas anesthetized in an IANB?

A

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

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9
Q

indication for giving an IANB

A
  1. procedures on multiple mandibular teeth
  2. when buccal soft tissue anesthesia is required anterior to the mental foramen
  3. when lingual soft tissue anesthesia is required
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10
Q

if pt. cannot open their mouth what can you not do?

A

Full IANB technique

- likely due to trismus

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11
Q

contraindications for IANB

A
  1. infection or actute inflammation in the area of the injection
  2. patients who might bite lips or tongue (very young child, handicaped patient)
  3. limitation to mouth opening *
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12
Q

Landmaks for preforming IANB?

A
  1. cornoid notch
  2. pterygomandibular raphe
  3. the occlusal plane of mandibular teeth
  4. contralateral premolars
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13
Q

position where you sit when giving an IANB on right side? left side?

A

right side = face patient and sit 8 oclock

left side - face same direction (face the patient) but sit at 10 oclock

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14
Q

pt. develops right sided facial paralysis. what happened?

A

facial nerve gets anesthetized

– needle goes beyond posterior border of the mandible into parotid

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15
Q

facial nerve controls muscles of the eye?

A

YES – so cant close the eye

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16
Q

opens the eye?

A

CN III

innervates LPS

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17
Q

CN VII action on eye and what it innervates

A

Innervates obicularis oris and is repsonsible for opening the eye

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18
Q

what happens if needle goes too deep in IANB?

A

could go into the parotid bed where cranial nerve 7 is and facial nerve paralysis

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19
Q

bone contact with IANB?

A

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

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20
Q

if you do not get adequate LA with an IANB what is likely the cause?

A
  1. too low (MOST COMMON)
  2. injection too far anterior
  3. ACCESSORY INNERVATION –
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21
Q

how to correct for accessory innervation in an IANB?

A

correct by

  1. lingual infiltrate
  2. PDL
  3. Inject lower for a bifid IAN
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22
Q

technique that has highest incidence of aspiration?

A

IANB (10-15%)

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23
Q

what is not anesthetized with an Incisve nerve block

A

the lingual soft tissues

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24
Q

incisive nerve block - explain general

A

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

25
Q

incisive nerve block contraindication

A

infection or acute inflammation in the area of injection

26
Q

advantages of the incisive nerve block

A

provides pulpal anesthesia without lingual anesethsia (could also be seen as a disadvanatge)

27
Q

after successful IAN block - make your soft tissue incision and the patient feels pain, what happened?

A

forgot to anesthetize the long buccal nerve

28
Q

what do you have to give with an IAN block when taking out a 3rd molar?

A

LONG BUCCAL NERVE BLOCK

- soft tissues and periosteium buccal tot he mandibular molar teeth

29
Q

areas anesthetized with a buccal nerve block? what type is this? when is it used?

A

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

30
Q

indications for a buccal nerve block?

A

when buccal soft tissue anesthesia is required for dental procedures in the mandibular molar region

31
Q

contraindications for buccal nerve block

A

infection or acute inflammation in the area of injection

32
Q

advantages to buccal nerve block

A

high success rate

technically easier

33
Q

disadvantages for buccal nerve block

A

potential for pain if the needle contacts the periosteum

34
Q

which is a ‘true’ mandibular nerve block?

A

Gow-gates

35
Q

nerves anesthetized in a gow-gates block?

A

7 total

  1. inferior alveolar
  2. lingual
  3. mylohyoid
  4. mental
  5. incisive
  6. auriculotemporal
  7. buccal (in 75% of pt’s)
36
Q

indications for gow-gates

A

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
37
Q

difference in areas anesthetized with IANB vs. Gow gates

A

skin over the zygoma, posterior portion of the cheek, and temporal region can be anesthetized in the gow-gates method via the auriculotemporal nerve **

38
Q

landmarks for Gow-gates

A
  1. mucous membrane on mesial of the ramus
  2. line from the intertragic notch to the corner of the mouth
  3. target area = condylar neck just below the insertion of the lateral pterygoid muscle
  4. height = just below the maxillary ML cusp of the 2nd molar
  5. site = penetrate just distal to the maxillary 2nd molar
39
Q

area of insertion for gow-gates

A

mucous membrane on mesial of the ramus

40
Q

target area for gow-gates

A

condylar neck just below the insertion of the lateral pterygoid muscle

41
Q

site of pentration in gow-gates

A

just distal to the maxillary 2nd molar

42
Q

contraindications for gow-gates

A
  1. infection or acute inflammation in the area of injection
  2. patients who might bite their lip or tongue
  3. patietns who are unable to open their mouth wide
43
Q

advantages of gow-gate

A

requires only one injection (vs. IANB with the long buccal)

- provides succesful anesthesia where a bifid IAN and bifid manibular canals are present

44
Q

epidural hematoma from what?

A

tearing middle meningeal artery if fracture the pterion of skull

45
Q

how could solution gain access to the cavernous sinus?

A

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

46
Q

temporary paralysis of CN III, IV, VI?

A

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

47
Q

complications of Goq-gates

A

hematoma
trismus - rate
temporary paralysis of CN III, IV, VI

48
Q

a pt. cannot open their mouth - which local anesthetic technique would you perform?

A

Vazirani-akinosi closed mouth block

49
Q

Vazirani-akinosi block - which nerves anesthetized?

A 
Inferior alveolar 
incisive 
mental
lingual
mylohyoid
50
Q

areas anesthetized with Vazirani-akinosi closed mouth block

A

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

51
Q

indications to perform Vazirani-akinosi closed mouth block

A
  1. limited ability in mandibualr opening

2 .inability to visualize the IANB landmarks

52
Q

contraindications to Vazirani-akinosi closed mouth block

A
  1. infection, acute inflammation
  2. patients who might bite themselves
  3. inability to visualize or gain access to lingual aspect of the ramus
53
Q

area of insertion for Vazirani-akinosi closed mouth block

A
  1. MANDIBULAR MEDIAL SOFT TISSUE
  2. adjacent to maxillary tuberosity
  3. height of muco-gingival junction adjacent to 3rd molar
54
Q

disadvanatges to Vazirani-akinosi closed mouth block

A

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

55
Q

indication for mental nerve block

A

soft tissue biopsies and sutering

56
Q

area anesthetized in mental nerve block

A

buccal mucous membrane anterior to the mental foramen to the midline and the skin of the lower lip

57
Q

triangulate what 3 hard tissue landmarks for IANB? what is at the center?

A
  1. coronoid notch
  2. mandibular angle
  3. posterior condyle
    center = approx. location of the mandibular foramen
58
Q

triangulate what 3 soft tissue landmarks for IANB? what is at the center?

A
  1. buccal tissues on mandible
  2. lateral pterygoid
  3. PMR - medial pterygoid
    center= approx. location of the mandibular foramen

Pain Control (12 decks)

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