Mandibular Nerve Block Pain Control, 9/30/11

Front 1

Describe preparation of the armamentarium

Back 1

1. insert cartridge - need to pull back on the handle first
2. Retract the piston
3. Engage the harpoon, do not exert force on the plunger. Screw the needle.

Front 2

What t technique should you always use when recapping the needle?

Back 2

Always use the scoop technique. You must retract the piston and remove the used cartridge.

Front 3

for the hand position, where do you have better control, palm up or palm down?

Back 3

Palm up and finger rest you'll have the best control.

Front 4

Name 4 techniques for mandibular anesthesia

Back 4

Inferior alveolar nerve block - Inferior alveolar nerve- pulpal tissue from 3rd molars up to incisive (incisive, mental - soft tissue to buccal aspect) and lingual - all the way back to 3rd molar, soft tissues. Buccal tissues anterior to first molar, lip numb, skin of chin will be numb. No soft tissue on buccal of the molars!
Incisive - premolars up to central incisors
Gow-Gates mandibular
Vazirini-Akinosi (closed mouth)

Front 5

Indications for inferior alveolar nerve block? Contraindications? What type of needle, and what's the positive aspiration percentage?

Back 5

-Procedures on multiple mandibular teeth
-Buccal soft tissue anesthesia is required anterior to first molar
-Lingual soft tissue anesthesia is required.

Contraindications
-Infection or acute inflammation in area of injection
-Patinets who might bite lips or tongue (kids, mentally handicapped)
-Limitation to open mouth (truisms)

5.7% positive aspiration, 25 gauge long needle

Front 6

Pterygomandibular raphe - what makes this?

Back 6

Superior pharyngeal constrictor and buccinator

Front 7

What do you palpate before inferior alveolar nerve block?

Back 7

Coronoid notch - bisecting line is where you want to put the needle in terms of the height. You want to go just lateral to the pterygomandibular raphe, contralateral to the premolars.

Resistance is okay but if you pull back, blood will flow back into it. Once you get blood into the cartridge, it will be difficult to see the second aspirate.

If you go in beyond 25 mm, then you know you're not in the right spot. If you're not hitting bone, your syringe may be too far forward. On edentulous patients, you're block will need to be higher.

Front 8

What gland is associated to the posterior part of the mandible?

Back 8

Parotid gland. If needle is too deep, local anesthetic solution could be injected within the parotid gland. Due to facial nerve, could cause paralysis.
Check for problems with speech, weakness in patients.

Front 9

What are some failures of inferior alveolar nerve block?

Back 9

-Deposition of the anesthetic solution too low
-Too far anterior
-Accessory innervation - may have mylohyoid nerve involvement. Tooth 19, from lingual take one tooth behind (tooth 18) know where apices are, get needle there, inject 0.5 cc and if its the mylohyoid nerve, it will get anything anterior to that.

Front 10

Incisive nerve block
Nerve anesthetized and areas anesthetized

Back 10

-Mental and incisive. Inject inot the area 0.5 cc and with finger, manipulate it into the foramen. Get the pulpal tissue of premolars and incisors.

Areas anesthetized: buccal mucous membrane anterior to the mental foramen to the mid line and skin of the lower lip
-pulpal nerve fibers to premolars, canine, and incisors

25 gauge short needle

Front 11

Indications of incivisor nerve block

Back 11

Indications:
-pulpal anesthesia on mandibular teeth anterior to the mental foramen
-when six or eight anterior teeth are treated

Front 12

Gow -Gates

Back 12

A true mandibular nerve block

Anesthetizes inferior alveolar, mental, incisive, lingual, mylohyoid, auriculotemporal, buccal (75%)

Gow Gates has a better success rate than Gow Gates. Aspiration is about 10 to 15% and less chance of having a positive aspirate.
-Usually use this as a reserve when inferior alveolar nerve block doesn't work.
-Positive aspiration 2%, 25 gauge long needle

Front 13

Extra oral and intra oral landmarks for Gow Gates

Back 13

Mesial palatal cusp of 2nd molar will be height along with intra tragal notch on the extra oral.

Front 14

Indications for Gow gates

Back 14

-multiple procedures on mandibular teeth
-Conventional inferior alveolar nerve block is unsuccesful
-Lingual soft tissue anesthesia is needed
-buccal soft tissue anesthesia is needed from 3rd molar to midline

Front 15

Vazirani - Akinosi Close Mouth Mandibular block

Back 15

Nerves anesthesized:
-Inferior alveolar
-incisive
-mental
0lingual
mylohyoid

Areas: mandibular teeth to midline, buccal mucoperiosteum and mucous membrane in front of the mental foramen

Front 16

What are the landmarks for Akinosi?

Back 16

No bony landmarks

-Anteiror 2/3s of tongue, floor of mouth
-Lingual soft tissues and periosteum

Indications - limited mandibular opening
-inabllity to visualize landmarks for IANB
- 25 gauge long needle

Front 17

Mental nerve block?

Back 17

-use for soft tissue biopsies
-Suturing of soft tissue
Nerves: mental nerve, terminal branch of inferior alveolar

Areas: buccal mucous membrane anterior to mental foramen to midline and skin of lower lip

Positive aspiration 5.7%
25 or 27 gauge short needle

Front 18

Buccal nerve block

Back 18

-Buccal nerve
-Soft tissues and periosteum buccal to mandibular molar teeth
Indications: when buccal soft tissue anesthesia is required

0.7% positive aspiration, use 25 gauge lon needle.
Insert mucous membrane D and B to most distal molar tooth in arch.