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10. mandibular anesthesia.pptx
- 2. objectives At the end of the lecture you are expected to know the techniques of true mandibular nerve block, vazirani akinosi, IAN, long buccal, lingual, mental, incisive nerve blocks
- 3. IANB (INFERIOR ALVEOLAR NERVE BLOCK) • Also called mandibular nerve block. • Second most frequently used after infiltration. • For quadrant dentistry. NERVES ANESTHETIZED – • Inferior alveolar nerve. • Incisive, Mental and Lingual nerves.
- 4. • TECHNIQUE – 25 gauge long needle is preferred • AREA OF THE INSERTION – • mucous membrane on the medial side of the ramus • Target area – inferior alveolar nerve as it passes downward before entering the mandibular foramen. • LANDMARKS – • Coronoid notch • Pterygomandibular raphe • Occlusal plane of mandibular teeth
- 6. Traditionally, the IA injection is described with an insertion point 1.0 cm above the mandibular occlusal plane. IA NB
- 7. • SIGNS AND SYMPTOMS – • Tingling or numbness – • Of the lower lip indicates anesthesia of the mental nerve. • Of the tongue indicates anesthesia of the lingual nerve. • PRECAUTIONS – • Do not deposit anesthesia when no bone contact • Do not contact bone forcefully • COMPLICATIONS – • Hematoma • Trismus • Transient facial paralysis
- 8. Incisive nerve block: • TECHNIQUES – 27 gauge short needle • Area of insertion – mucobuccal fold at or just anterior to the mental foramen • Target area – mental foramen through which the mental nerve exits and inside of which incisive nerve is located. • Landmarks – mandibular premolars and mucobuccal fold. • FAILURES OF ANESTHESIA – • Inadequate volume of anesthetic solution • Failure to achieve anesthesia of second premolar • COMPLICATIONS – • Hematoma • Paresthesia of lip and chin
- 9. Gow-Gates Mandibular (Open-Mouth) Nerve Block • George A. E. Gow-Gates first published this technique in 1973. • True mandibular nerve block • Significant advantages of the Gow-Gates technique over the IA nerve block include its higher success rate, it slower incidence of positive aspiration, and the absence of problems with accessory sensory innervation to the mandibular teeth. • The Gow Gates injection anesthetizes the inferior alveolar, lingual, auriculotemporal, buccal (75% of the time), and mylohyoid nerves. • The injection blocks the nerves at a point that is proximal to their division into inferior alveolar, buccal, and lingual nerves.
- 10. Bennett C.R, Trigeminal Nerve. In: Monheim’s Local anaesthesia and pain control in dental practise.7:CBS;2010:26-53
- 12. The needle endpoint is the lateral aspect of the anterior portion of the condyle, just inferior to the insertion of the lateral pterygoid muscle. A 25-gauge long needle is inserted slowly to a depth of 25 to 30mm; the end point is inferior and lateral to the condylar head.
- 13. Gow Gates Mandibular anesthesia technique
- 14. Vazirani-Akinosi (Closed- Mouth) Nerve Block • In 1977, Dr. Sunder J. Vazirani and Dr. Joseph Akinosi reported on a closed mouth approach to mandibular anesthesia. • It is an intraoral approach to provide both anesthesia and motor blockade in cases of severe unilateral trismus. This injection is useful for patients with trismus because it is performed while the jaw is in the physiologic rest position • Other common names – Tuberosity technique.
- 15. This form of injection, also known as the closed mouth mandibular block, anesthetizes the inferior alveolar, lingual, buccal, and mylohyoid nerves. A 25-gauge long needle is inserted parallel to the maxillary occlusal plane at the height of the maxillary buccal vestibule. AREAS OF INSERTION – soft tissue in the lingual border of the mandibular ramus directly adjacent to the maxillary tuberosity at the height of the mucogingival injection adjacent to the maxillary third molar.
- 16. • TARGET AREA – soft tissue of the medial border of the ramus where they run towards the mandibular foramen. • The depth of insertion will vary with the anteroposterior size of the patient’s ramus. • TheVazirani-Akinosi injection is performed ‘‘blindly’’ because no bony endpoint exists. • However, in adult patients, a rule of thumb is that the hub of the needle should be opposite the mesial aspect of the maxillary second molar. • COMPLICATION – hematoma, trismus, facial nerve paralysis
- 18. Regional Anesthesia to Soft Tissue Mental Nerve Block : • this injection technique can be useful when bilateral anesthesia is desired for procedures on premolars and anterior teeth. • A 25- or 27-gauge short needle is inserted at the mucobuccal fold at or just anterior to the mental foramen, which is typically located between the apices of the 2 premolars • The difference between the mental nerve block and the incisive nerve block is that the incisive nerve block requires pressure to direct local anesthetic solution into the mental foramen.
- 19. • INDICATIONS – • soft tissue biopsies and suturing of soft tissues. • COMPLICATIONS – • Hematoma. • Paresthesia of lip/chin.
- 20. Buccal Nerve Block : • Also called long buccal nerve block and buccinator nerve block. • The buccal injection will anesthetize the buccal soft tissue lateral to the mandibular molars. • The needle is inserted into the tissue in the distobuccal vestibule opposite the second or third mandibular molar just medial to the coronoid notch until bone is contacted (approximately1to 3 mm), and 0.25 mL of anesthetic is deposited. • A 25 gauge long needle is recommended (because the
- 21. • TECHNIQUES – 25 Gauge Needle • AREAS OF INSERTION – mucous membrane distal and buccal to the most distal molar tooth in the arch. • TARGET AREA – buccal nerve as it passes over the anterior border of the ramus. • LANDMARKS – mandibular molars, mucobuccal fold
- 22. • Direct the syringe, facing downward towards bone and parallel to the occlusal plane. • Penetrate the mucous membrane at the injection site, distal and buccal to the last molar. • INDICATIONS – • Scaling and curettage. • Placement of a rubber dam clamp on soft tissues. • Removal of subgingival caries. • Subgingival tooth preparation. • Placement of gingival retraction cord. • Placement of matrix bands. • DISADVANTAGES – painful if contacts the periosteum • COMPLICATIONS – Hematoma.
- 23. Lingual nerve block • The lingual nerve block will anesthetize the lingual gingiva, floor of the mouth, and tongue from the third molar anteriorly to the midline. This nerve may be anesthetized directly, by inserting the needle as in the IA to approximately 10mm and injecting.
- 24. Recommended volumes of local anesthetic solution for mandibular injection technique TECHNIQUE VOLUME,ml Inferior alveolar 1.5ml Buccal 0.3ml Mental 0.6ml Incisive 0.6 - 0.9ml Gow – Gates 1.8 - 3.0ml Vazirani – Akinosi 1.5 – 1.8ml
- 25. Thank You