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DOH210 S1 > Week Three: Local Anaesthetic Anatomy and Armamentarium > Flashcards

Week Three: Local Anaesthetic Anatomy and Armamentarium Flashcards

1
Q

Describe a cartridge of LA

A 
Closed. 
1.8ml or 2.2ml of solution (clear)
4 parts
• Cylindrical tube (glass or plastic)
• Name, composition, vasoconstrictor, Expiry date
• Rubber stopper
• Aluminium cap
• Rubber diaphragm
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2
Q

Describe a dental Needle

A
  • Stainless steel /disposable, single use ONLY
  • Consist of bevel, shank, hub & syringe end
  • Length- given in mm
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3
Q

What are the main different needle lengths?

A
  • long 40mm (Long)

* short 25mm (Short)

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4
Q

What is important about knowing the gauge of a needle?

A

Gauge- diameter of the lumen of needle
• The smaller the number the larger the diameter
• Generally 27 gauge & 30 gauge used
• Higher gauge than this may make it difficult to aspirate.

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5
Q

Describe a labelled needle.

A

IMAGE

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6
Q

What is the bevel on a needle?

A

• Present to ensure easy, painless puncture of
soft tissue
• Bevel of needle must be orientated so that it
faces bone during injection. This is to avoid
pain from needle tip dragging across
persiosteum of bone.

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7
Q

What are some MUST KNOWS! About the needle?

A

Unscrew both ends simultaneously and bend
slightly for opening
!!!! After use disassemble with artery forceps needle and dispose in sharps container immediately!
!!! Bevel must face bone when performing injections
to avoid tearing of periosteum

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8
Q

What is the syringe?

A

• Provides the means of delivering the anaesthetic
solution from the cartridge, through the needle, to the
patient
• Non Aspirating, Aspirating or self aspirating

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9
Q

Describe a labelled syringe.

A

IMAGE

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10
Q

What are the steps to load a syringe?

A
  • Load cartridge into syringe by pulling pack piston/plunger
  • Engage piston/plunger with rubber stop of cartridge (to enable aspiration)
  • Needle inserted and screwed onto needle adapter/thread at front of barrel
  • Needle penetrates adapter and pierces rubber diaphragm of cartridge
  • Apply slight pressure onto thumb ring- check flow
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11
Q

Describe a self aspirating syringe.

A
  • Spring mechanism that aids automatic aspiration
  • After needle insertion into soft tissue, decrease the pressure on the thumb ring slightly (achieved by releasing thumb slightly)
  • Goal is to create slight negative pressure, so that a few micro litres are sucked from tissue spaces into the syringe, and operator can assess if the needle is in a blood vessel or not
  • +ve aspiration: (blood in cartridge) do not deposit solution, discard cartridge and replace
  • -ve aspiration: SLOWLY deposit solution
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12
Q

The Trigeminal Nerve - How many divisions?

A

CNV - 3 Divisions

  • Opthalmic CNV1 (sensory)
  • Maxillary CNV2 (sensory)
  • Mandibular CNV3 (sensory and motor)
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13
Q

What is this?

IMAGE

A

Trigeminal ganglion

Ganglion = collection of cell bodies of sensory nerves

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14
Q

What type of nerve is the CNV1?

A

The ophthalmic division is a general sensory nerve.

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15
Q

Where does the CNV1 have all its cell bodies located?

A

Trigeminal ganglion

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16
Q

Where is the CNV1 cranial exit?

A

Superior Orbital Fissure

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17
Q

Where does the CNV1 distribute?

A 
Superior CTR
- Frontal: Supraorbital & Supratrochlear
Within CTR
- Nasocilary: Long ciliary, Ganglionic, Post. and Ant. Ethmoidal, Infratrochlear
- Lateral CTR: Lacriminal
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18
Q

What are the functions of the CNV1

A

Sensory: Snesation from corneam skin of forehead, scalp, eyelids, nose and mucosa of nasal cavity and paranasal sinuses.

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19
Q

What type of nerve is the CNV2?

A

The maxillary Division is a general sensory nerve

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20
Q

Where are the cell bodies of the CNV2 located?

A

Trigeminal ganglion

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21
Q

Where is the cranial exit for the CNV2?

A

Foramen Rotundum

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22
Q

Where is the CNV2 distributed?

A
  • Main trunk (middle Cranial Fossa)
    Meningeal
  • Main trunk (Pterygopalatine Fossa)
    Posterior Superior Alveolar (PMF > PSA canal & MT)

Zygomatic (IOF): Zygomatictemporal, Zygomaticofacial

Infraorbital (IOF->IO canal > Infraorbital foramen): , Middle Superior Alveolar, Anterior Superior Alveolar, Terminal branches ( Palpebral, nasal, Superior
labial)

Pterygopalatine Ganglion (Pterygopalatine Fossa)
Palatine (PPC)
Greater (GPC > GPF)
Lesser (LPC > LPC)
Nasal
Nasopalatine (SPF) > IF)
Posterior Superior Nasal (SPF)
Orbital (IOF)
Pharyngeal (PVC)
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23
Q

What is the function of the CNV2?

A

Sensation of the face over the maxilla, Upper lip, maxillary teeth, mucosa of the nose, hard and soft palate, maxillary sinuses.

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24
Q

What type of nerve is the CNV3?

A

The mandibular division is a general sensory and brachial motor nerve

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25
Q

Where are the cell bodies of the CNV3 located?

A

Sensory: Trigeminal Ganglion

Branchial Motor: Pons

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26
Q

Where is the cranial exit of the CNV3?

A

Foramen Ovale

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27
Q

What is the distribution of the CNV3?

A 
Main Trunk
Meningeal (back into skull via foramen
spinosum)
Medial pterygoid nerve
Anterior trunk (MAINLY MOTOR)
Masseteric
Deep Temporal
Nerve to Lateral Pterygoid
Buccal
Posterior Trunk (MAINLY SENSORY)
Auriculotemporal
Lingual
Inferior Alveolar
Mylohyoid
28
Q

What are the functions of the CNV3?

A

Sensory: Sensation from skin over mandible,
lower lip, Mandibular teeth, TMJ, oral
mucosa, anterior 2/3 of the tongue.

Motor: Muscles of mastication, mylohyoid,
anterior belly of digastric, tensor veli
palatine, tensor tympani

29
Q

The infraorbital nerve provides sensation for?

A

Maxillary central and lateral incisors

30
Q

The zygomaticotemporal nerve innervates?

A

Sensory information from skin over the zygomatic arch

31
Q

The Zygomaticofacial nerve innervates?

A

Sensory information from skin over the zygomatic bone.

32
Q

The Anterior superior alveolar nerve innervates?

A

The buccal periosteum, connective tissue, buccal gingiva and muco-membrane adjacent to these teeth.

33
Q

The middle superior alveolar nerve innervates what?

A

Maxillary premolars, MB root of 16/26, Buccal periosteum, connective tissue, buccal gingiva and mucous membrane adjacent to premolars.

34
Q

What does the posterior superior alveolar nerve innervate?

A

Maxillary molars, buccal periosteum, connective tissue, buccal gingiva and mucous membrane adjacent to these teeth

35
Q

Which nerves are present in the CNV2 ‘Maxillary Division’ (branches in the pterygopalatine fossa)

A

(branches in the pterygopalatine fossa)

  • Posterior Superior Alveolar Nerve
  • Infraorbital - Middle Superior Alveolar
  • Infraorbital - Anterior Superior Alveolar
  • Infraorbital - Terminal branches (Palpebral, nasal, superior labial)
36
Q

Which nerves are present in the CNV2 ‘Maxillary Division’ (branches in the pterygopalatine fossa) Zygomatic

A

Zygomaticotemporal

Zygomaticofacial

37
Q

In the maxillary division CNV2: What nerves branch within the pterygopalatine ganglia?

A
  • The Greater Palatine Nerve
  • The lesser Palatine Nerve
  • Nasopalatine Nerve
  • Posterior Superior Nasal
38
Q

What does the Greater palatine nerve innervate?

A

Palatal Mucosa and Gingiva of posterior 2/3 of the hard palate.

39
Q

What does the lesser palatine nerve innervate?

A

Supplies the mucous membrane on both surfaces of the soft palate and on the tonsils

40
Q

What does the nasopalatine nerve innervate?

A

Palatal mucosa and anterior 1/3 of the hard palate, palatal gingiva 3-3

41
Q

What does the posterior superior nasal nerve innervate?

A

It is sensory to the posterosuperior quadrant of the lateral wall of the nasal cavity

42
Q

Quick Facts about the CNV3?

A

The CNV3 - The mandibular division
Emerges from the foramen ovale
Largest of the three divisions

43
Q

What is the main trunk of the CNV3?

A
  • Meningeal (back into skull via foramen spinosum

- Medial pterygoid nerve (motor innervation to this muscle)

44
Q

What is the Anterior trunk of the CNV3?

A
  • Masseteric
  • Deep Temporal
  • Nerve to Lateral Pterygoid
  • Buccal (sensory)
45
Q

What is the Posterior trunk of the CNV3?

A

This is mainly sensory:

  • Auriculotemporal
  • Lingual
  • Inferior Alveolar
  • Mylohyoid (motor)
46
Q

Of the Anterior trunk of the CNV3, which are the muscular branches?

A
  • Deep Temporal (anterior and posterior)
  • Nerve to lateral Pterygoid
  • Masseteric Nerve
47
Q

What is the path and course of the Buccal Nerve?

A

It follows the inferior part of the temporal muscle and emerges under the anterior border of the masseter, continuing in an anterolateral direction.

At the level of the occlusal plane adjacent to the lower 7 & 8 it crosses over the anterior border of the ramus of the mandible and enters the cheek by piercing the buccinator.

48
Q

How does the buccal nerve relay sensory information?

A

It receives sensory information from the skin of the cheek and buccal mucosa.
Smaller branches of the buccal nerve pass into the retro molar region to innervate the buccal gingiva of the lower posterior teeth, and the adjacent mucobuccalfold

49
Q

What does the auriculotemporal Nerve innervate?

A

The sensory to parotid gland, TMJ, Skin over temporal and auricular region.

50
Q

What is the path an course of the inferior alveolar nerve?

A

Runs inferiorly from lower border of the lateral pterygoid muscle. It is positioned posteriolaterally to the lingual nerve and descends by way of the sphenomandibular ligament, medial pterygoid muscle and medial aspect of the ramus.

As it enters the ramus via the mandibular foramen into the mandibular canal. In the canal it gives
off dental, interdental & inter radicular branches to molars and premolars

51
Q

What are the two terminal branches of the Inferior Alveolar Nerve?

A

The Mental Nerve and the Incisive Nerve

52
Q

What is the path and course of the mental nerve?

A

Emerges from the mandibular foramen and divides beneath depressed angularis oris.

53
Q

What is the path/course of the incisive nerve?

A

Remains in the mandibular canal and forms nerve plexus with same nerve from opposite side

54
Q

What is the IAN sensory to?

A

Sensory to the mandibular teeth

55
Q

What is the Mental Nerve sensory to?

A

Sensory to skin of chin, lip skin, mucosa and muscles of the lower lip

56
Q

What is the Incisive nerve sensory to?

A

Sensory to the anterior mandibular teeth. 3-3, and adjacent buccal mucosa.

57
Q

What is the path and course of the lingual nerve?

A

It passes inferiorly and medially to lateral pterygoid muscle. As it descends it lies between the ramus of mandible and medial pterygoid muscle. In the pterygomandibular space.
It runs anteromedially to IAN - whose path it parallels
Enters the FOM (floor of mouth), just posterior to the eights, quite superficial at this stage. Travels deep to the tongue, across mylohyoid close to the submandibular gland, then extends terminal branches to deep surface of the sublingual gland and tip of tongue.

58
Q

What is the lingual nerve sensory to?

A

Anterior 2/3 of the tongue, floor of mouth and lingual gingiva.

59
Q

The pterygomandibular space has borders, what are they?

A
  • Superior Border
  • Inferior Border
  • Lateral Border
  • Medial Border
  • Posterior Border
  • Anterior Border
60
Q

Where is the superior border?

A

Lower head and lateral pterygoid muscle

61
Q

Where is the Inferior border?

A

Medial pterygoid m. attachment to medial surface of ramus of mandible (apex of triangle)

62
Q

Where is the lateral border?

A

Medial surface of the ramus

63
Q

Where is the Medial border?

A

Medial pterygoid muscle

64
Q

Where is the posterior border?

A

Parotid Gland

65
Q

Where is the anterior border?

A

Oral mucosa & posterior part of buccinator muscle./ Pterygomandibular raphe

DOH210 S1 (15 decks)

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