techniques of mandibular injections Flashcards
what is the second most frequently injection used after infiltration?
IA block
what nerves are anesthetized with the IA block?
IA nerve
incisive, mental, and lingual nerves
the anatomic location of the lingula
at or below 1.0 cm above the mand occ. plan _____% of the time
84%
the anatomic location of the lingula
at or below 1.5 cm above the mand occ. plan _____% of the time
96%
the anatomic location of the lingula
_______% distally fo the mesiodistal length of the ramus
60%
where should you approach for the IA block?
from the contralateral premolars
T/F you shoudl be 1.0 cm above the mand occlusal plane and perpendicular to it
false: 1.5 cm above the mand occlusal plane and parallel to it
the needle endpoint should be _______% of the __________ length of the ramus, distally
60%, mesiodistal
T/f it is required that you hit the bone on the IA block
true
what gauge needle for the IA block?
25 gauge long needle
how far do you withdraw for the IA?
1mm
how much of the carpule of local anesthetic over how long?
3/4 of the carpule over 1-2 min
(inject 1/4 carpule, re-aspirate; inject 1/4, re-aspirate)
withdraw the needle 1/2 way (_______mm) during the IA block
~10-15mm
why will you withdraw during the IA block?
to slowly inject the lingual nerve
T/f you don’t need to save any anesthetic for the long buccal
false
what is the clinical failure rate for the IA block?
15-20%
what is a common issue with IA block?
wide variation in anatomy
-anesthetic too low, too anteriorly
limited access to IAN
accessory innervation
-mylohyoid nerve
T/f it’s ok to give bilateral IA blocks
False. can bite themselves etc
what are the complications of IA block?
syncopal episode
hematoma (bruise)
trismus (trouble opening)
transient facial paralysis
SHTT
where does the long buccal block get numb?
soft tissue on buccal from just posterior to molars up to the premolar area (where mental nerve exits mental foramen)
where is the long buccal block injection given?
distal and buccal to 2nd molar
what’s the depth of penetration for long buccal block
2-3mm (bone contact)
~1/5th of carpule
where will you give the lingual nerve block?
inserted distally and lingually to the 3rd molar area to the depth of ~5mm no bone contact
what does the lingual n. block get numb?
lingual gingiva, mucosa, floor of the mouth, and anterior 2/3 of tongue
where do you place incisive nerve block?
mental nerve and rub into foramend
does the incisive nerve block give 100% profound pulpal anesthesia?
no
what nerves get numb with incisive nerve block?
mental, incisive
what do you do fi the conventional IA block is unsuccessful?
Gow-Gates nerve block
what is the most important contraindication for Gow-gates nerve block?
pt’s who are unable to open their mouth wide? (e.g. trismus)
T/F gow-gates is a true V3 nerve block
true
what branches are numb with the gow-gates nerve block?
IA
lingual
auriculotemporal
mylohyoid
long buccal
where do you want to inject for Gow-Gates?
the lateral aspect of the anterior portion of the condylar head
how long must the pt remain wide open for ________ minutes after the injection for gow gates
1-2 min
for gow gates you’re injecting just inferior to the insertion of the ________ pterygoid muscle
lateral
where do you position the needle for gow-gates?
beginning form the contralateral canine, the needle is positioned for insertion at a level just inferior to mesiolingual cusp of 2nd molar
what is the alternate approach for gow-gates?
puncture point is made approximately at the location of the distobuccal cusp of the 2nd molar
what is the needle insertion depth of gow-gates?
25-30mm
what’s the idea behind having the bone contacted during gow-gates?
prevents injection into the capsule of the TMJ
what is the success rate of gow-gates?
> 95% when you’re proficient
when do you use the akinosi block?
limited mandibular opening
inability to visualize landmarks for the IA block due to large tongue
what nerves will be anesthetied with vazirani-akinosi block?
IA
incisive
mental
lingual
mylohyoid
(NOT long buccal)
what are the disadvantages of vazirani-akinosi block?
-difficult to visualize the path of the path of the needle and depth of insertion
-no bony contact; depth of penetration somewhat arbitrary
-potentially traumatic if needle is too close to periosteum
bevel orientation _________ from ramus with vazirani-akinosi block
away
what is the depth of the vazirani-akinosi block?
25mm
T/f with vazirani-akinosi block you’ll be perpendicular to the max occlusal plane
false. parallel
where do you insert needle for vazirani-akinosi block?
into mucosa b/w medial border of mandibular ramus and the max tuberosity at the level of the cervical margin of the max molars
what areas are anesthetized with vazirani-akinosi block?
-mand teeth to midline
-buccal mucoperiosteum and mucous membranes on the side of injection
-ant. 2/3 of tongue and floor of oral cavity
-lingual soft tissues and periosteum
-body ob mandible, inferior portion of the ramus
-skin over the zygoma, post portion of the cheek and temporal regions
