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intro to OS and pain management > mandibular injections > Flashcards

mandibular injections Flashcards

1
Q

buccal nn location btwn what mm?

A

Buccal Nerve
Between Lateral Pterygoid Heads

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2
Q

buccal nn functions

A

Sensory to Cheek Area
Sensory to Molar Buccal Gingiva

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3
Q

buccal nn injection site

A

anterior aspect of the ramus/lateral

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4
Q

buccal nn block needle

A

Injection – 25 Gauge Long Needle

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5
Q

what to do with tissue in buccal nn block

A

stretch tissue

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6
Q

what should you contact with needle in buccal nn block

A

periosteum

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7
Q

Buccal Nerve Block
Tissues Anesthetized

A

*Gingiva buccal to molars
*Retromolar pad mucosa
*Buccal mucosa in molar area
*NO hard tissues anesthetized

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8
Q

Buccal Nerve Block
Indications

A

*When buccal soft tissue
anesthesia is required

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9
Q

Buccal Nerve Block
Advantages

A

*High success rate
*Easy injection to administer
*Atraumatic

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10
Q

Mandibular Nerve
Posterior Division branches

A

Primarily sensory
*Auriculotemporal nerve
*Lingual nerve
*Inferior alveolar nerve
*Mylohyoid nerve

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11
Q

Auriculotemporal Nerve
Areas Innervated

A

*Skin over areas supplied 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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12
Q

Auriculotemporal Nerve location

A
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13
Q

second branch of posterior division of man nn

A

lingual nn

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14
Q

Lingual NerveInnervates:

A

Innervates Anterior 2/3 of Tongue
nnervates Lingual Mucosa

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15
Q

Lingual Nerve Blocked With:

A

*Inferior Alveolar Block
*Mandibular Block
*Gow-Gates Mandibular Block
*Vazirani-Akinosi Block
*Infiltration in lingual sulcus

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16
Q

what block is this?

A

lingual infiltration

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17
Q

Largest Branch of Posterior Division

A

IA

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18
Q

foramen and ligament associated with IA

A
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19
Q

what landmark is used for typical IA blocks

A

coronoid notch, want needle injected at this level from across the arch at contralateral PM region

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20
Q

when doing an IA block what mm is penetrated

A

buccinator

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21
Q

Inferior Alveolar Nerve Block
Penetration Lateral to:

A

Lateral to Pterygomandibular Raphe

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22
Q

Inferior Alveolar Nerve Block
Site Between what landmarks?

A

Raphe and Notch

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23
Q

steps to IA block

A
  1. dry site
  2. topical anesthetic, wait 1-2min
  3. Finger on Notch Retracts Cheek and
    Determines Height of Injection
  4. Note Site of Needle Insertion
  5. Barrel of Syringe in Corner of Mouth
  6. Insert~25mm to Contact Bone
  7. Aspirate, Inject 1.5 ml over 60 Sec.
  8. Withdraw Halfway, Deposit 0.1 ml at
    Lingual Nerve
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24
Q

Inferior Alveolar Nerve Block
Nerves Anesthetized

A

*Inferior alveolar
*Incisive
*Mental
*Lingual (usually)

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25
Q

Inferior Alveolar Nerve Block
Indications

A

*Wide area requires anesthesia
*Buccal tissue anesthesia is needed
*Lingual soft tissue anesthesia is
needed

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26
Q

Inferior Alveolar Nerve Block
Contraindications

A

*Infection in area
*Acute inflammation in area
*Patient a potential lip-biter

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27
Q

Inferior Alveolar Nerve Block
Advantages

A

*Provides wide area of anesthesia
*Minimizes anesthetic dose

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28
Q

Inferior Alveolar Nerve Block
Disadvantages

A

*Wide area anesthetized
*Unsuccessful in 15 to 20%
*Inconsistent oral landmarks
*10-15% positive aspiration

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29
Q

Inferior Alveolar Nerve Block
Alternatives

A

*Mental nerve block
*Incisive nerve block
*Gow-Gates block
*Vazirani-Akinosi block
*Intraosseous or intraseptal
injection

30
Q

Terminal Branch of Inferior Alveolar

31
Q

locating the mental nn

A

palpate the foramen/radio

32
Q

injection site of mental block

A

depth of vestibule

33
Q

steps to mental block

A
  1. dry area
  2. topical
  3. orient needle (bevel to bone)
  4. Insert into Tissue Over Foramen
    Deposit 0.6 ml over 20 seconds.
34
Q

Mental Nerve Block
Areas Anesthetized

A

*Mucosa anterior to foramen
*Skin of the lower lip
*Chin

35
Q

Mental Nerve Block
Indications

A

*Soft tissue anesthesia
*Suturing lip lacerations
*Biopsies of lip tissue

36
Q

Mental Nerve Block
Contraindications

A

*Infection in the area
*Acute inflammation

37
Q

Mental Nerve Block
Advantages

A

*High success rate
*Technically easy
*Usually entirely atraumatic

38
Q

Mental Nerve Block
Disadvantages

A

*Hematoma
*Positive aspiration 5.7 %

39
Q

Incisive Nerve is the terminal branch of?

A

Terminal Branch of Inferior Alveolar

40
Q

Incisive Nerve
Supplies:

A

Incisors, Canine,
Premolar(s)

41
Q

incisive nn cross inn

A

possible in the ant region

42
Q

Incisive Nerve Block technique

A

Identical to Mental Block With
Pressure Maintained 2 Minutes

43
Q

lingual anestheisa for maxillary anteriors

A

Trans-Papilla Injection for
Lingual Anesthesia

44
Q

Incisive Nerve Block
Areas Anesthetized

A

*Mucosa on buccal
*Lower Lip
*Skin of the chin
*Premolars, canines,
incisors

45
Q

Incisive Nerve Block
Indications

A

*Procedures on anterior teeth
*When inferior alveolar block is not
indicated
*To avoid bilateral mandibular
blocks

46
Q

Incisive Nerve Block
Contraindications

A

*Infection
*Acute inflammation

47
Q

Incisive Nerve Block
Advantages

A

*Provides pulpal and hard tissue anesthesia without lingual anesthesia
*High success rate

48
Q

Incisive Nerve Block
Disadvantages

A

*No lingual anesthesia
*May be sensory overlap at
midline (rare)
*Positive aspiration 5.7 %

49
Q

Gow-Gates Nerve Block

A

target at condylar level for true Mandibular Nerve Block

50
Q

Gow-Gates Nerve Block
Needle Contacts:

A

Gow-Gates Nerve Block
Needle Contacts Neck of Condyle

51
Q

GG extraoral landmarks

A

corner of mouth and intertragic notch

52
Q

mouth opening with GG

A

wide open causing translation of condyle

53
Q

Gow-Gates Nerve Block
Needle Puncture Point Dictated by:

A

Gow-Gates Nerve Block
Needle Puncture Point Dictated by
Intra-oral Landmarks

54
Q

GG advance needle until:

A

bone contacted

55
Q

once bone contacted with GG what should you do?

A

Withdraw 1 mm, Aspirate,
Inject 1.8 ml

56
Q

Gow-Gates Nerve Block
Nerves Anesthetized

A

*Inferior Alveolar
*Lingual
*Mylohyoid
*Auricolotemporal
*Buccal (in 75 %)

57
Q

Gow-Gates Nerve Block
Indications

A

*Multiple procedures
*Buccal anesthesia required
*Lingual anesthesia required
*Minimal dose of anesthetic

58
Q

Gow-Gates Nerve Block
Contraindications

A

*Infection in area
*Inflammation in area
*Potential lip-biter
*Restricted mouth opening

59
Q

Gow-Gates Nerve Block
Advantages

A

*95-99% success rate !
*Single injection
*Minimal aspiration rate
*Few complications

60
Q

Gow-Gates Nerve Block
Disadvantages

A

*Longer onset, >5 minutes)
*No intraoral landmarks

61
Q

Vazirani-Akinosi Nerve Block used how?

A

closed mouth

62
Q

Vazirani-Akinosi Nerve Block
Height of Injection

A

between GG and IA block

63
Q

intraoral landmark for Vazirani-Akinosi Nerve Block

64
Q

Vazirani-Akinosi Nerve Block path of insertion

A

directly parallel to ramus and on medial aspect

65
Q

Vazirani-Akinosi Nerve Block needle insertion depth
aspirate?
inject how much?

A

Insert to 25 mm Depth
Aspirate, Inject 1.5 to 1.8 ml

66
Q

Vazirani-Akinosi Nerve Block
Nerves Anesthetized

A

*Inferior Alveolar
*Lingual
*Mylohyoid

67
Q

Vazirani-Akinosi Nerve Block
Indications

A

*Limited mouth opening
*Multiple procedures
planned
*Landmarks poorly visible
for other injections

68
Q

Vazirani-Akinosi Nerve Block
Contraindications

A

*Infection in area
*Inflammation in area
*Potential lip-biter
*Inadequate access

69
Q

Vazirani-Akinosi Nerve Block
Advantages

A

*Relatively atraumatic
*No need to open mouth
*Aspiration rate <10 %

70
Q

Vazirani-Akinosi Nerve Block
Disadvantages

A

*Difficult visualization
*No bony contact
*Arbitrary insertion depth

intro to OS and pain management (8 decks)

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