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Pain & Anxiety Control > Module 13 > Flashcards

Module 13 Flashcards

1
Q

what are the three branches of V3

A
  • undivided nerve
  • anterior division
  • posterior division
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2
Q

what is involved in the undivided nerve of V3

A
  • medial pterygoid branch
  • dura mater branch
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3
Q

what is involved in the anterior division of V3

A
  • lateral pterygoid branch
  • masseter muscle branch
  • temporal muscle branch
  • LONG BUCCAL NERVE
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4
Q

what is involved in the posterior division of V3

A
  • auriculotemporal branch
  • LINGUAL NERVE
  • mylohyoid nerve
  • INFERIOR ALVEOLAR NERVE
  • MENTAL NERVE
  • incisive nerve (terminal branches)
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5
Q

what are the 4 MAJOR branches of V3

A
  • inferior alveolar nerve
  • lingual nerve
  • long buccal nerve
  • mental nerve
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6
Q

what are examples of mandibular injections

A
  • conventional mandibular block
  • Gow-Gates mandibular block
  • Uni-linear mandibular block
  • Vazirani-akinosi mandibular block
  • mental nerve block
  • mylohyoid nerve block
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7
Q

ALL mandibular nerve blocks use a full carpule EXCEPT __

A

mental & mylohyoid nerve blocks –> use 1.0 cc

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8
Q

what is the most challenging area of the orofacial complex to anesthetize

A

inferior alveolar nerve

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9
Q

why is the inferior alveolar nerve so difficult to anesthetize

A
  • structural complexity of V3
  • entire division is freely movable along with the mandibular structures which it innervates
  • bone is more compact so local infiltration is NOT effective
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10
Q

what does the inferior alveolar nerve provide sensation to

A
  • mandibular teeth
  • body of the mandible, inferior portion of the ramus
  • buccal mucoperiosteum, mucus membrane anterior to the mental foramen
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11
Q

the inferior alveolar nerve descends __ and __ across the pterygoid space

A

inferiorly & laterally

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12
Q

what are the 2 branches that the inferior alveolar nerve forms

A

anteriorly = lingual nerve
posteriorly = mylohyoid nerve

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13
Q

the inferior alveolar nerve enters the mandible through the ___ and transverse beneath the roots of the mandibular teeth to the ___

A
  • mandibular foramen
  • mental foramen
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14
Q

at the mental foramen the inferior alveolar nerve splits into two branches, what are these two branches?

A
  • exiting the foramen = mental nerve
  • remaining in the mandible = incisive nerve
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15
Q

the incisive nerve can cross the ___ to the opposite ___ and possibly the opposite ___

A
  • midline
  • incisors
  • mandibular foramen
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16
Q

the lingual nerve descends ___ and ___ between the ramus and medial pterygoid muscle

A

inferiorly & medially

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17
Q

the lingual nerve runs anterior and slightly medial to the ___ & just distal and medial to the ___

A
  • inferior alveolar nerve
  • third molar
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18
Q

the lingual nerve extends inferiorly to the ___

A

tongue

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19
Q

what does the lingual nerve provide sensation to

A
  • anterior 2/3 of tongue
  • floor of mouth
  • lingual gingiva
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20
Q

the long buccal nerve branches off of ___

A

anterior division of V3

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21
Q

the long buccal nerve descends parallel to the ___ and ___

A
  • lingual nerve
  • inferior alveolar nerve
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22
Q

at the ___ the long buccal nerve swings laterally and fans up and out over the area of the buccal mucosa

A

retromolar pad

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23
Q

what does the long buccal nerve provide sensory information to

A
  • buccal gingiva of molar/premolar area
  • skin of the cheek

NO innervation of the lip

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24
Q

in order to accomplish restorative and surgival procedures involving the tissues of the MANDIBULAR DIVISION –> the following nerves and their respective branches must be anesthetized USING ONE CARPULE

A
  • inferior alveolar nerve
  • lingual nerve
  • long buccal nerve
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25
Q

which nerve provides pulpal innervation to the mandibular teeth?

a - long buccal nerve
b - inferior alveolar nerve
c - lingual nerve
d - nerve to mylohyoid

A

b - inferior alveolar nerve

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26
Q

T/F blocking the mandibular division nerve is subject to a high percentage of success

A

false - failure

due to dynamic nature of target zone and difficulty in visualization

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27
Q

what are the two target zones for the conventional mandibular block

A
  • posterior zone
  • anterior zone
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28
Q

what is included in the posterior zone of the conventional mandibular block

A
  • inferior alveolar nerve
  • lingual nerve
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29
Q

what is included in the anterior zone of the conventional mandibular block

A
  • long buccal nerve
  • targeted in separate injection
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30
Q

what is the posterior target area

A

retromolar triangle

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31
Q

what is the medial border of the retromolar triangle

A

pterygomandibular raphe

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32
Q

what is the lateral border of the retromolar triangle

A

anterior border of the ramus of the mandible

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33
Q

what is the superior border of the retromolar triangle

A

hamular notch

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34
Q

what is the posterior target area characterized by

A

a dimple / depression found roughly in the center of the triangle

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35
Q

what are the 3 parameters to consider with a conventional mandibular block

A

1 - height = 6 - 10 mm above occlusal plane
2 - 3/4 of A-P distance from the CORONOID NOTCH back to the deepest part of the PTERYGOMANDIBULAR RAPHE
3 - bone contact = 2/3 - 3/4 of needle length

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36
Q

what needle is used in the conventional mandibular block

A

25 long

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37
Q

how much of the needle is inserted in the conventional mandibular block

A

2/3 - 3/4 of needle length until BONE CONTACT

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38
Q

T/F positive aspiration is common in the conventional mandibular block

A

true - 10-15%

39
Q

in a conventional mandibular block, after reaching the target, slowly deposit the entire carpule except for ___

40
Q

what is the specific technique of the conventional mandibular block

A

align the barrel of the syringe with the contralateral premolars - parallel with the occlusal plane

41
Q

in the conventional mandibular block the posterior target zone is forgiving regarding the precision of the needle placement as long as ___

A

depth is reached

42
Q

the posterior target zone of the conventional mandibular block lies along the line that is defined by ___ and ___

A
  • deepest extent of the mesial concavity of the ascending ramus
  • deepest extent of the posterior concavity of the ramus
43
Q

the extension of the line of the posterior target zone of the conventional mandibular block is

A

parallel to the occlusal plane defined by the mandibular teeth

44
Q

what varies from patient to patient and can present as a barrier to the direct approach of reaching the target zone of the conventional mandibular block

45
Q

how do you adjust your treatment of a patient with a prominent lingula presenting as a barrier to reaching the target zone of the conventional mandibular block

A
  • penetrate the dimple
  • swing the barrel of the syringe toward the midline in order to reach the posterior target area
46
Q

while giving the conventional mandibular block, you encounter what you think is a prominent lingula, preventing you from reaching the target site. What do you do?

a - give up and go home
b - swing the barrel of the syringe from the contralateral premolar area (where you began with your conventional block) in towards the midline, thus redirecting your needle to a more medial position allowing you to get around the lingula
c - swing the barrel of the syringe from the contralateral premolar are (where you began with your conventional block) out towards the contralateral molar, thus redirecting your needle to a more medial position allowing you to get around the lingula

A

b - swing the barrel of the syringe from the contralateral premolar area (where you began with your conventional block) in towards the midline, thus redirecting your needle to a more medial position allowing you to get around the lingula

47
Q

what is the anterior target are of the long buccal nerve block

A

anterior border of the ramus

48
Q

where is penetration of the mucosa made in the long buccal nerve block

A
  • distal & buccal to the most distal molar tooth in the arch
  • needle parallel to the occlusal plane but buccal to the teeth
  • reposition if necessary to 45 degree angle laterally
49
Q

what needle is used for a long buccal nerve block

50
Q

how much of the needle is inserted in a long buccal nerve block

A

until bone is contacted –> 1-4 mm

51
Q

how much anesthetic is deposited with a long buccal nerve block

52
Q

what must you make sure of with al ong buccal nerve block

A

that the bevel is buried

repositioning is often required

53
Q

how does the target zone of the Gow-Gates mandibular block differ from the conventional block

A

significantly SUPERIOR

54
Q

does the Gow-Gates mandibular block have a shorter or longer onset of anesthesia

A

longer –> 5 - 10 minutes

55
Q

Gow-Gates mandibular block is successful with ___ / ___

A
  • bifid IAN
  • bifid mandibular canals
56
Q

where is the target area of the Gow-Gates mandibular block

A

anteromedial side of the condylar neck

57
Q

where is penetration of the mucosa in the Gow-Gates mandibular block

A

needle placed distal to the max 2nd molar at height of tip of ML cusp (3rd molar if present)

58
Q

in the Gow-Gates mandibular block, the syringe barrel is aligned with the imaginary line between ___ & ___

A
  • intertragus notch (injection side)
  • corner of the mouth (opposite side)
59
Q

after giving the Gow-Gates mandibular block what must be occur

A

pt sits upright for 5 min w/ mouth open for 1-2 min

60
Q

what needles is used in the Gow-Gates mandibular block

61
Q

how much of the needle is inserted in the Gow-Gates mandibular block

A

3/4 needle length –> bone contact

62
Q

what do you do to adjust if bone is not originally contacted in the Gow-Gates mandibular block

A

retract slightly and redirect needle anteriorly and syringe barrel posteriorly

63
Q

___ of needle in the Gow-Gates mandibular block is usual cause of missing bone

A

medial deflection

64
Q

T/F in the Gow-Gates mandibular block the needle bevel is critical in the success rate

A

false - NOT critical

65
Q

how much of a carpule is injected in the Gow-Gates mandibular block

A

full carpule

66
Q

the uni-linear mandibular block target zone is approximately ___ to the target for the conventional mandibular block

A

1 cm superior

67
Q

the target zone of the uni-linear mandibular block is an area where what nerves are closest together

A
  • IAN
  • lingual nerve
  • long buccal nerve

they run parallel in close proximity in a straight line

68
Q

where does penetration of the mucosa occur in the uni-linear mandibular block

A
  • 5 mm above the dimple of the posterior triangle
69
Q

how much of the needle is inserted in the uni-linear mandibular block

A

1/2 - 2/3 needle length –> bone contact

70
Q

what is the specific technique of the uni-linear mandibular block

A
  • swing barrel to opposite side (C/P area)
  • advance until bone is contacted
  • withdraw 2 mm & deposit 3/4 carpule
  • slowly withdraw, depositing remaining carpule
71
Q

what is the target area of the Vazirani-Akinosi block

A

medial border of the ramus

72
Q

what must you beware of with the Vazirani-Akinosi block

A

lateral flare of the ramus

73
Q

what is the specific technique for the Vazirani-Akinosi block

A
  • mouth closed, light occlusion
  • syringe barrel = parallel to max occlusal plane
  • needle inserted at mucogingival junction of max 2nd molar (3rd molar if present) & advanced in slightly lateral direction
74
Q

T/F bone is NOT contacted in the Vazirani-Akinosi block

75
Q

what needle is used for the Vazirani-Akinosi block

76
Q

how much of the needle is inserted in the Vazirani-Akinosi block

A

3/4 neddle length from max tuberosity

77
Q

what is the specific techniwue of the Vazirani-Akinosi block

A

bevel is AWAY from the mandibular ramus

CRITICAL!!

78
Q

how much of a carpule is used in the Vazirani-Akinosi block

A

full carpule (1.8 cc)

79
Q

how is the patient positioned in the Vazirani-Akinosi block

80
Q

which of the following has the most superior target area in the retromolar triangle in the posterior zone?

a - Vazirani-Akinosi mandibular block
b - Conventional mandibular block
c - Gow-Gates mandibular block

A

c - Gow-Gates mandibular blcok

81
Q

what is the target area of the mental nerve block

A
  • mental foramen
  • between apices of 1st & 2nd premolars
82
Q

where is penetration of the mucosa made in the mental nerve block

A
  • depth of the vestibule
  • anterior or posterior to neurovascular bundle (palpate)
83
Q

what needles is used in the mental nerve block

A

25 long or 27 short

84
Q

how much of the needle is inserted in the mental nerve block

A

deep enough to bury the bevel (3-5 mm)

85
Q

how much of a carpule is used in the mental nerve block

A

1/2 carpule (1.0 cc)

86
Q

what is a specific technique of the mental nerve block

A

apply pressure on the area that has “ballooned”

87
Q

what does the mylohyoid nerve provide sensory innervation to

A

mandibular molars

88
Q

what is the indication for a mylohyoid nerve block

A

successful mandibular block has been given BUT patient still has some sensation in some mandibular teeth (particularly molars)

89
Q

what is the target area of the mylohyoid nerve block

A
  • lingual approach
  • just medial to mandibular 2nd molar
90
Q

where does penetration of the mucosa occur in the mylohyoid nerve block

A
  • depth of lingual vestibule
  • 45 degree angle to long axis of the mandibular 2nd molar
91
Q

what needle is used for the mylohyoid nerve block

A

25 long or 27 short

92
Q

how much of the needle is inserted in the mylohyoid nerve block

A

1/4 - 1/3 needle length –> bone contact

93
Q

how much of the carpule is injected in the mylohyoid nerve block

A

1/2 carpule (1.0 cc)

Pain & Anxiety Control (12 decks)

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