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D2 Summer > Pain and Anxiety Week 4 > Flashcards

Pain and Anxiety Week 4 Flashcards

1
Q

3 divisions of the trigeminal nerve

A

V1 - ophthalmic
V2 - maxillary
V3 - mandibular

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2
Q

What are the major branches of V2? (6)

A

1) PSA
2) MSA
3) ASA
4) Greater palatine
5) Nasopalatine
6) Infraorbital

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3
Q

What are the 7 possible maxillary injections?

A

1) PSA
2) MSA
3) ASA
4) Greater palatine
5) Nasopalatine
6) Infraorbital
7) Supraperiosteal injection (local infiltration)

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4
Q

What does the MSA nerve block anesthetize?

A

Premolars
1st molar (primarily)
Buccal gingiva in premolar/1st molar regions

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5
Q

What is the target area for MSA nerve block?

A

Slightly apical to premolars (either 1st or 2nd)

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6
Q

How is the penetration of the mucosa made when giving MSA nerve block?

A

Along long axis of premolar to the apex of premolar

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7
Q

What needle is used for MSA, PSA, ASA, Greater Palatine, and Nasopalatine nerve blocks and Supraperiosteal Injection?

A

27 short

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8
Q

How much of the needle is inserted when giving MSA nerve block?

A

1/3 to 1/2 the needle length

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9
Q

Bevel is toward the _________ when giving MSA, PSA, ASA, Nasopalatine, and Infraorbital nerve blocks and Supraperiosteal Injection

(not Greater Palatine!!!)

A

bone

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10
Q

What does the PSA nerve block anesthetize?

A

1st molars (partial innervated by MSA)
2nd molars
3rd molars
Buccal gingiva in molar regions

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11
Q

What is the target area for PSA nerve block?

A

Apical to root of 3rd molar

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12
Q

How is the penetration of the mucosa made when giving PSA nerve block?

A

Lateral to 2nd molar
45 degree angle to long axis of tooth
At an angle approaching 45 degrees medially

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13
Q

What must you avoid when giving PSA nerve block?

A

Pterygoid plexus

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14
Q

How much of the needle is inserted when giving PSA nerve block?

A

1/2 the needle length

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15
Q

What does the ASA nerve block anesthetize?

A

Anterior teeth (centrals, laterals, canines)
Labial mucosa and inner lip to midline

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16
Q

What is the target area for ASA nerve block?

A

Apical and distal to canine

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17
Q

How is the penetration of the mucosa made when giving ASA nerve block?

A

Along long axis of canine to target area

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18
Q

Make sure to pull the _____ tight when giving ____ nerve block

A

lip; ASA

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19
Q

How much of the needle is inserted when giving ASA nerve block?

A

1/3 to 1/2 the needle length

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20
Q

What does the Greater Palatine nerve block anesthetize?

A

No teeth
Palatal soft tissue (from distal of canine to junction of hard and soft palate; medial to midline)
Palatal bone (same)

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21
Q

What is the Greater Palatine nerve block also called?

A

Anterior Palatine nerve block

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22
Q

What is the target area for Greater Palatine nerve block?

A

Greater palatine foramen

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23
Q

How is the penetration of the mucosa made when giving Greater Palatine nerve block?

A

Anterior to greater palatine foramen
1/2” medial to disto-palatal cusp of 2nd molar
Needle positioned perpendicular to mucosa

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24
Q

What do you use to located the greater palatine foramen?

A

Cotton tip

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25
Q

Make sure to apply pressure to the cotton tip applicator until the tissue ________

A

blanches

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26
Q

Keep pressure on cotton tip applicator during __________ and first couple drops; ease pressure as anesthetic is delivered

A

penetration

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27
Q

How much of the needle is inserted when giving Greater Palatine nerve block?

A

Until bevel is buried (~ 1/4”)

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28
Q

Bevel is positioned ________ toward _______ tissue when giving Greater Palatine nerve block

A

laterally; soft

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29
Q

What does the Nasopalatine nerve block anesthetize?

A

No teeth
Palatal soft tissue (anterior hard palate, from distal of canine to distal of canine)
Palatal bone (same)

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30
Q

What is the Nasopalatine nerve block also called?

A

Incisive nerve block

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31
Q

What is the target area for Nasopalatine nerve block?

A

Incisive foramen

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32
Q

How is the penetration of the mucosa made when giving Nasopalatine nerve block?

A

Lateral to incisive papilla toward posterior part of the papilla
45 degree angle to palatal bone

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33
Q

T/F: You need to use a cotton tip applicator when before and during Greater Palatine and Nasopalatine nerve block

A

True

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34
Q

How much of the needle is inserted when giving Nasopalatine nerve block?

A

Until bevel is buried (~ 1/8”)

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35
Q

What does the Infraorbital nerve block anesthetize?

A

Canine
Incisors (to midline)
*75% = premolars + part of 1st molar
Buccal gingiva of the above areas
Lower eyelid
Upper lip
Lateral aspect of nose

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36
Q

What is the target area for Infraorbital nerve block?

A

Near infraorbital foramen
Inferior to orbital rim

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37
Q

How is the penetration of the mucosa made when giving Infraorbital nerve block?

A

Parallel to 1st premolar
Angle toward infraorbital foramen

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38
Q

What size needle is used for Infraorbital nerve block?

A

25 long or 27 short

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39
Q

How much of the needle is inserted when giving Infraorbital nerve block?

A

Until bone is contacted; about 1/2 the needle length

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40
Q

What does the Supraperiosteal Injection anesthetize?

A

Pulpal anesthesia for 1-2 teeth
Soft tissue anesthesia of limited area

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41
Q

What is the Supraperiosteal Injection commonly called?

A

Local infiltration

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42
Q

What is the success rate of the Supraperiosteal Injection?

A

> 95%

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43
Q

What is the target area for Supraperiosteal Injection?

A

Apical region of the tooth being anesthetized

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44
Q

How is the penetration of the mucosa made when giving Supraperiosteal Injection?

A

Along long axis of tooth to target zone

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45
Q

When giving Supraperiosteal Injection, insertion is made at the _______ of the ______________ fold. Needle is then advanced to the apical region of the tooth

A

height; mucogingival

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46
Q

T/F You should always recap a needle by using the single handed technique

A

True

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47
Q

T/F You should always recap the penetrating end of the needle before disposing into sharps container

A

FALSE, you should NEVER recap the penetrating end

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48
Q

Which branch of V3?

Medial pterygoid branch
Dura mater branch

A

Undivided nerve

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49
Q

Which branch of V3?

Lateral pterygoid branch
Masseter muscle branch
Temporal muscle branch
Long buccal branch

A

Anterior division

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49
Q

Which branch of V3?

Auriculotemporal branch
Lingual nerve
IAN
Mental nerve
Incisive nerve - terminal branches

A

Posterior division

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50
Q

What are the 4 major branches of V3?

A

IAN
Lingual nerve
Long buccal nerve
Mental nerve

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51
Q

Which nerve is the most challenging area of the oro-facial complex to anesthetize?

A

IAN

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52
Q

Why is the IAN he most challenging area of the oro-facial complex to anesthetize?

A
  1. Structural complexity of V3
  2. Entire division is freely movable
  3. Bone is more compact
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53
Q

T/F: Local infiltration of anesthetic is very effective for IAN block

A

FALSE; the bone is more compact, so local infiltration is NOT effective for IAN

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54
Q

IAN descends _________ and __________ across the pterygoid space

A

inferiorly; laterally

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55
Q

What branches does IAN form after descending across the pterygoid space?

A

Lingual nerve (anteriorly)
Mylohyoid nerve (posteriorly)

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56
Q

What foramen does IAN enter after branching into lingual nerve and mylohyoid nerve?

A

Mandibular foramen

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57
Q

What foramen does the IAN enter after going through the mandibular foramen and transversing beneath roots of mandibular teeth?

A

Mental foramen

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58
Q

What does IAN divide into after entering the mental foramen?

A

Mental nerve (exits foramen)
Terminal IAN branches (remain in mandible)

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59
Q

Terminal IAN branches (incisive nerve) can cross the ___________ - usually opposite to incisors but can extend to opposite mandibular foramen

A

midline

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60
Q

Lingual nerve descends _____________ and ______________ between the ramus and medial pterygoid

A

inferiorly; medially

61
Q

After descending, the lingual nerve runs ___________ and slightly __________ to the _________

A

anterior; medial; IAN

62
Q

Lingual nerve runs just ________ and _________ to the ___ molar

A

distal; medial; 3rd

63
Q

Lingual nerve extends inferiorly to the ____________

A

tongue

64
Q

What does the lingual nerve provide innervation to?

A

Anterior 2/3rds tongue
Floor of mouth
Lingual gingiva

65
Q

The long buccal nerve branches off the _____________ division of V3

A

anterior

66
Q

Long buccal nerve descends ___________ to the _______ and ________ nerve

A

parallel; IAN; lingual

67
Q

At the retromolar pad, the long buccal nerve swings ___________ and fans up and out over the buccal mucosa

A

laterally

68
Q

What is the long buccal nerve also known as?

A

Buccal nerve

69
Q

What does the long buccal nerve provide innervation to?

A

Buccal gingiva or molar/premolar area
Skin of cheek

70
Q

T/F: Long buccal nerve provides innervation to the lip

A

FALSE

71
Q

T/F: There is some overlap between terminal branches of long buccal nerve and mental nerve

A

True

72
Q

In order to accomplish restorative and surgical procedures involving the tissues of the Mandibular Division, the following nerves and their respective branches must be anesthetized (using one anesthetic carpule) …

A

IAN
Lingual nerve
Long buccal nerve

73
Q

T/F: Blocking the Mandibular Division nerves is subject to a high percentage of failure

A

True

74
Q

Why is blocking the Mandibular Division nerves subject to a high percentage of failure?

A
  1. The dynamic nature of the target zone
  2. The relative difficulty in visualizing its 3D aspects
75
Q

Name the 4 different types of mandibular blocks

A

Conventional
Uni-linear
Gow-Gates
Vazirani-Akinosi

76
Q

What are the 2 target zones of the conventional mandibular block?

A

Posterior zone: IAN + lingual

Anterior zone: long buccal

77
Q

T/F: The anterior zone of the conventional mandibular block is targeted in a separate injection from the posterior zone

A

True

78
Q

What is the posterior target zone of the conventional mandibular block?

A

Retromolar triangle

(IAN as it passes down to mandibular foramen, but prior to entry)

79
Q

What is the posterior target zone of the conventional mandibular block defined by?

A
  1. Pterygomandibular Raphe (medially)
  2. Anterior border of the Ramus (laterally)
  3. Hamular notch (superiorly)
80
Q

What is the posterior target zone of the conventional mandibular block characterized by?

A

Dimple/depression found in the center of the retromolar triangle

81
Q

What is the height of injection for the conventional mandibular block?

A

6-10 mm above occlusal plane

82
Q

What is the anterior-posterior placement of the needle for the conventional mandibular block?

A

3/4 of the A-P distance from the coronoid notch back to deepest part of pterygomandibular raphe

83
Q

What is the depth of penetration for the conventional mandibular block?

A

Until bone is contacted

(20-25 mm, or 2/3-3/4 depth of long needle)

84
Q

What needle is used for the conventional mandibular block?

A

25 long

85
Q

When doing the conventional mandibular block, align barrel of syringe with contralateral premolars, __________ with the occlusal plane

A

parallel

86
Q

When doing the conventional mandibular block, insertion is made to about ______ to ________ needle length, until _____ is contacted

A

2/3 to 3/4; bone

87
Q

When doing the conventional mandibular block, make sure the bevel is _________ the bone

A

toward

88
Q

How common is positive aspiration when doing the conventional mandibular block?

A

10-15%

89
Q

When doing the conventional mandibular block, once you reach the target, you want to ________ deposit the entire carpule except for ___ carpule

A

slowly; 0.2 cc

90
Q

T/F: the posterior target zone of the conventional mandibular block is quite small, and is forgiving regarding the precision of needle placement as long as depth is reached

A

FALSE; should say the posterior target zone of the conventional mandibular block is quite LARGE

91
Q

The posterior target zone of the conventional mandibular block lies along a line defined by the deepest extent of the ________ concavity of the ascending ramus, and the deepest extent of the __________ concavity of the ramus

A

mesial; posterior

92
Q

Which injection can the lingula present a barrier to direct approach to the target zone of?

A

Mandibular conventional block

93
Q

T/F: Lingula varies from patient to patient

A

True

94
Q

What do you do if the lingula is a prominent barrier when trying to give a conventional mandibular nerve block?

A
  1. Penetrate “dimple”
  2. Swing barrel toward midline to reach posterior target area
95
Q

What is the anterior target zone of the long buccal nerve block?

A

Anterior border of ramus

96
Q

When doing the long buccal nerve block, penetration of the mucosa is made _______ and _________ to the most distal molar tooth in the arch

A

distal; buccal

97
Q

When doing the long buccal nerve block, the needle is ___________ to the occlusal plane, but __________ to the teeth

A

parallel; buccal

98
Q

What needle is used for the long buccal nerve block?

A

25 long

98
Q

What is the correct way to reposition your needle if necessary (shallow tissue) when doing a long buccal nerve block?

A

45 degree angle laterally

99
Q

When doing the long buccal nerve block, insert the needle until _______ is contacted, about _________mm

A

bone; 1-4mm

100
Q

When doing the long buccal nerve block, make sure the __________ is buried; repositioning needle is often necessary

A

bevel

101
Q

When doing the long buccal nerve block, bevel is __________ the bone

A

toward

102
Q

How does the Gow-Gates target zone differ from the conventional block target zone?

A

Gow-Gates target zone is significantly superior

103
Q

T/F: The Gow-Gates mandibular block has a high success rate (>95%), but requires experience

A

True

104
Q

Which technique has a longer onset of anesthesia? Gow-Gates or Conventional?

A

Gow-Gates (5-10 mins vs 3-5 for conventional)

105
Q

What is the aspiration rate for Gow-Gates?

A

Low (2%)

106
Q

Which mandibular block technique results in successful anesthesia with bifid IAN/bifid mandibular canals?

A

Gow-Gates

107
Q

Gow-Gates target zone is _____ cm superior to the conventional target zone

A

2 cm

108
Q

Where is the target zone for the Gow-Gates mandibular block?

A

Anteromedial side of condylar neck

109
Q

When doing the Gow-Gates mandibular block, the needle is placed just _______ to the maxillary 2nd molar at the height of the tip of the _______ cusp (3rd molar if present)

A

distal; ML

110
Q

When doing the Gow-Gates mandibular block, the syringe barrel is aligned with the imaginary line between the _______________ _______ (injection side) and the __________ of the mouth (opposite side)

A

intertragus notch; corner

111
Q

What should you do after injecting your patient using the Gow-Gates mandibular block technique?

A

Sit patient up for 5 mins with mouth open for 1-2 mins

112
Q

What needle is used for the Gow-Gates mandibular block?

A

25 long

113
Q

When doing the Gow-Gates mandibular block, insertion is made until _______ is contacted, about ______ needle length

A

bone; 3/4

114
Q

When doing the Gow-Gates mandibular block, if bone is not contacted, you must retract slightly and redirect needle by moving syringe ___________, which will redirect the needle ___________

A

posteriorly; anteriorly

115
Q

___________ _________ of needle is usual cause of missing bone when doing the Gow-Gates mandibular block

A

Medial deflection

116
Q

T/F: The orientation of the needle bevel is very critical when doing the Gow-Gates mandibular block

A

FALSE; the orientation of the needle bevel is NOT critical

117
Q

When doing the Gow-Gates mandibular block, _________ deposit a __________ carpule

A

slowly; full

118
Q

T/F: The Uni-linear mandibular block utilizes a different target zone and less than half the anesthetic that is required for Gow-Gates

A

True

119
Q

How many injections does the Uni-linear mandibular block require?

A

1

120
Q

Uni-linear target zone is _____ cm superior to the conventional target zone

A

1 cm

121
Q

Name the location where the IAN, lingual nerve, and long buccal nerve are closest together, meaning they are:

–running parallel
–in close proximity
–in a straight line

A

Uni-linear target zone → 1 cm above conventional target zone

122
Q

When doing the Uni-linear mandibular block, you want to penetrate the mucosa ______ mm above dimple of posterior triangle

A

5 mm

123
Q

When doing the Uni-linear mandibular block, you want to insert the needle ______ to ______ its length

A

1/2 to 2/3

124
Q

When doing the Uni-linear mandibular block, swing barrel to opposite side (C/P area) and advance until _________ is contacted. Then withdraw ______ mm and deposit ________ carpule. Slowly withdrawal, and the deposit the remaining carpule (this anesthetizes lingual and long buccal)

A

bone; 2 mm; 3/4

125
Q

Where is the target zone for the Vazirani-Akinosi mandibular block?

A

Medial border of ramus

(same height as Uni-lateral)

126
Q

What should you be aware of when finding the target zone for the Vazirani-Akinosi mandibular block?

A

Lateral flare of ramus

127
Q

T/F: When doing the Vazirani-Akinosi mandibular block, you want to make sure the patient’s mouth is closed with light occlusion

A

True

128
Q

When doing the Vazirani-Akinosi mandibular block, the syringe barrel is _________ to maxillary occlusal plane

A

parallel

129
Q

When doing the Vazirani-Akinosi mandibular block, needle is inserted at _______________ __________ of maxillary ______ molar (3rd if present) and advanced in a slightly _________ direction

A

mucogingival junction; 2nd; lateral

130
Q

When doing the Vazirani-Akinosi mandibular block, ________ is NOT contacted

A

bone

131
Q

T/F: When doing the Vazirani-Akinosi mandibular block, bone should always be contacted

A

FALSE; bone is NOT contacted

132
Q

What needle is used for the Vazirani-Akinosi mandibular block?

A

25 long

133
Q

When doing the Vazirani-Akinosi mandibular block, insertion is made to about ________ the needle length from the _________ _________

A

3/4; maxillary tuberosity

134
Q

When doing the Vazirani-Akinosi mandibular block, bevel is _____________ from the bone

A

AWAY

135
Q

T/F: When doing the Vazirani-Akinosi mandibular block, you should use a full carpule (1.8 cc) and sit pt upright

A

True

136
Q

What is the target zone for the mental nerve block? Where can it be found?

A

Mental foramen, between apices of 1st and 2nd premolars

137
Q

When doing the mental nerve block, penetration is made in depth of the _________, just anterior or posterior to ____________ bundle (palpate!)

A

vestibule; neurovascular

138
Q

What needle is used for the mental nerve block?

A

25 long
27 short

139
Q

When doing the mental nerve block, insertion is made deep enough to _________ the _______ of the needle (3-5 mm)

A

bury; bevel

140
Q

When doing the mental nerve block, bevel is ___________ the bone

A

toward

141
Q

When doing the mental nerve block, apply ___________ on the area that has “____________”

A

pressure; ballooned

142
Q

What can the mylohyoid nerve provide innervation to?

A

Mandibular molars

143
Q

When is the mylohyoid nerve block indicated?

A

When a successful block has been given, but pt still has sensation in some teeth (particularly molars)

144
Q

“While it has been postulated that several nerves can provide accessory innervation to mandibular teeth, current thinking supports the ____________ as the likely culprit.”

A

mylohyoid

145
Q

What is the target zone of the mylohyoid nerve block?

A

Medial to mandibular 2nd molar

(take a lingual approach)

146
Q

When doing the mylohyoid nerve block, penetrate the depth of the lingual ___________

A

vestibule

147
Q

When doing the mylohyoid nerve block, use a ______ degree angle to the long axis of the ________

A

45 degree; molar

148
Q

What needle is used for the mylohyoid nerve block?

A

25 long
27 short

149
Q

When doing the mylohyoid nerve block, insertion is made about _______ to ________ the needle length until ________ is contacted (lingual border of body of mandible)

A

1/4 - 1/3; bone

150
Q

When doing the mylohyoid nerve block, bevel is _________ the bone

A

toward

D2 Summer (37 decks)

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