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79 Cards in this Set
- Front
- Back
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What is the anterior division of the mandibular division of the trigeminal nerve?
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- Muscles of Mastication: (1) Temporalis (2) Masseter (3) Lateral Pterygoid
- Buccal NErve |
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What is the posterior division of the mandibular division of the trigeminal nerve?
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- Auriculotemporal
- Lingal - Inferior Alveolar - Myloid Nerve |
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Inferior Alveolar Nerve Block.
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- AKA mandibular nerve block
- Most common used - Highest rate of failure (15-20%) - Useful in qudrant dentistry - Try to avoid bilateral mandibular blocks (uncomfortable to patient) - Most dfficult block to master |
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What are the nerves anesthetized in the IAN block?
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- Inferior Alveolar
- Mental - Incisive - Lingual (usually) |
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What are the IAN indications?
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- procedures on multiple teeth in one quadrant
- buccal and lingual soft tissue required |
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What are contraindications for IAN block?
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- infection or acute inflammation
- tonge and lip biters (children, mentally handicapped) |
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What is an advantage of the IAN block?
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- one injection provides a wide area of anesthesia
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What are the disadvantages of an IAN block?
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- sometimes not necessary for localized areas/procedures
- high block failure rate -intra-oral landmarks are not consistent - high rate of positive aspiration - lingual and lip anesthesia (biters and hot beverages) |
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Where is the insertion of the IAN block?
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- the mucosa on medial aspect of the mandibular ramus
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What is the target of the IAN block?
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The inferior alveolar nerve before it enters the foramen.
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What are the landmarks of the Inferior Alveolar Nerve block?
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- Coronoid Notch (greatest concavity on the anterior border of the ramus)
- Pterygoid mandibular raphe - occlusal planeof the mandibular posterior teeth |
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What are failures of the IAN block?
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- deposition of anesthetic below mandibular foramen
- depositon of anesthetic too far anteriorly - Accessory innervation of mandibular teeth (mylohoid nerve posteriorly and mylohoid/ overlapping fibers of contralateral IAN) - bifid inferior alveolar nerve (lower) |
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What are complications associated with the IAN block?
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- Hematoma (hold pressure)
- Trismus - Facial paralysis (anesthetic in parotid) |
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What is the IAN technique?
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- place index finger or thumb on the coronoid notch, pull tissue tight
- 6-10 mm above the occlusal plane of the mandible or the middle of the finger thumb determines the height of injection - the anterioposterior point of hte injection is then 3/4 distance to the pterygomandibular raphe - align the barrel of the syringe across the contralateral premolars - Height of injection: (1) 6-10 mm above the occlusal plane (2) coronoid notch - A-P site of injection: into base of "v" formed by pterygomandibular raphe and ramus of mandible - Penetration depth: 20-25 mm, 2/3-3/4 the lenght of the long needle |
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In the IAN block, what if bone i contacted too soon?
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- redirect, withdraw the needle slightly but not completely
- swing the barrel of the syringe around to the ipsilateral canine area - Advance slightly - may feel needle move across the lingula - swing barrel of the syringe back around to the contralateral premolar area - advance to appropriate depth, aspirate, inject slowly |
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What is the technique for the adjunctive mylohyoid block?
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- Retract the tongue to midline, then inject at hte apical area of second molar on the lingual surface of the mandible.
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What is the technique for the djunctive contralateral inferior alveolar block?
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- Supraperiosteal injection technique across the mdline of the anterior mandibular teeth (buccal surface).
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What is the technique for the adjunctive lingual nerve block?
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- deposit 0.1 to 0.2 ml of anesthetic when withdrawing needle from the inferior alveolar block.
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What are signs and symptoms of an Inferior Alveolar Block?
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- tingling or numbness of lip and chin to mandible
- tingling or numbness of the ipsilateral anterior two thirds of the tongue - anestheia of teeth and gingiva ipsillaterally (except buccal nerve distribution) |
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Buccal Nerve Block
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- AKA Long Buccal Nerve Block
- Anesthetizes soft tissues and periosteum buccal to the mandibular incisors |
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What are the indications for the buccal nerve block?
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- buccal soft tissue anesthesia for procedurs on the mandibular molars
(this includes rubber dam clamp, taking out wisdom teeth) |
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What are contraindications for the buccal nerve block?
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infection/inflammation in the area
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What are the advantages of the Buccal nerve block?
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- easy, high success rate
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what are the disadvantages of the buccal nerve block?
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- potentially painful if perosteum is torn (etomosis)
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What is the insertion of the buccal nerve lock?
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- mucosa distal and buccal to the most posterior mandibular molar.
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What is the target for the buccal nerve block?
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- buccal nerve as it passed over the anterior border of the ramus
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What are the landmarks for the buccal nerve block?
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- mandibular molars
-mucobuccal fold |
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T/F: The buccal nerve block has a high failure rate.
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False - failure is quite rare.
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What are the complications of the buccal nerve block?
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- rare (hematoma)
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What is the technique of the buccal nerve block?
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- penetrates mucosa about 2mm before contact bone
- aspirate and inject |
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Gow-Gates Block
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- AKA mandibular block
- blocks entire distribution of V3 - anesthesia of inferior alveolar, lingual, mental, incisive, mylohoid, bucca, and auriculotempora nerves - difficult learning curve - more successful than inferior alveolar block |
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What are the indications for the Gow-gates block?
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- procedures on multple teet
- soft tissue anesthesia - failed inferior alveolar block (this is the most common) |
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What are the contraindications for the Gow-gates block?
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- infection/inflammation
- tongue/lip biters - patients who are unable to open mouth wide (3 fingers wide is necessary) |
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What are the advantges of the Gow gates block?
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- only one injection
- high success rate (95%) - minimal complications successful anesthesia of bifd inferior alveolar nerves |
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What are the disadvantages ofthe Gow-gates block?
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- tongue/lip anesthesia
- longer time to onset of anesthesia - high learning curve. |
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Where is the insertion for the Gow-gates block?
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-mucosa on the mesial of ramus in line of tragus and commissure distal to the maxillary second molar.
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where is the target for the Gow-gates block?
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- lateral surface of condylar neck, below insertion of lateral pterygoid
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Where are the landmarks for the gow-gates block?
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- tragus and commissure
- just below the mesiopalatal cusp of the maxillary second molar |
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What are the failures for the Gow-gates block?
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- insufficient volume of anesthetic (bigger nerve)
- anatomical difficulties (do not deposit anesthetic unless bone is contacted) |
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What are the complications of the Gow-gates block?
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- hematoma (rare)
- trismus (rare) - paralysis of canial nerve III, IV, VI (eye paralysis, diplopia) |
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Technique of Gow-gates block.
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- have pt open wide, point of insertion below mesiopalatal cusp of mxillary second molar aiming to tragus of ear (considerably higher than occlusal plane)
- advance needle 20-25 mm until bone is contacted aspirate and inject - have pt stay open 1-2 minutes after injection. |
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Akinosi Block
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- aka closed mouth block
- useful when dental therapy required in patients with limited mouth opening (trismus) |
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Indications for Akinosi Block.
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- limited mouth opening
- inability to visualize landmarks for conventional block |
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Contraindications of Akinosi Block.
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- infection or acute inflammation
- lip/tongue bitters - inability to gain access to the lingual apsect of ramus |
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Advantages of Akinosi Block.
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- no mouth oening required
- works on patients with bifid inferio alveolar nerves - lower aspiration rate/ atraumatic |
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Disadvantages of Akinosi Block
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- difficult to visualize path of needle and depth of insertion
- no bone contact |
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Insertion of Akinosi Block.
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- soft tissue overlying medial border of ramus adjacentto maxillary tuberosity at the mucogingival junction height
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Target of Akinosi Block.
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- soft tissue of the medial ramus (below Gow-gates and above inferior alveolar block)
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Landmarks of Akinosi Block.
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- mucogingival junction of maxillary (second/third molar)
maxillary tuboristy/ coronoid notch |
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Failures of Akinosi Block.
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- must stay in line with flare of themandible or injection will be too lateral
- needle nsertion too low - under/overinsertion of the needle. |
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Complications of Akinosi Block
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- hematoma/trismus
- facial nerve paralysis (overinsertion into parotid gland) |
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Technique of Akinosi Block.
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- bevel needle away from bone
- advance needle 25 mm - aspirate - inject |
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Mental/Incisive Block.
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- the mental nerve leaves the mental foramen and provides sensory innervation to the lip and chin area
- the incisive nerve continues forward to provide sensorty innervation to anterior mandibular teeth - both have limited usefulness on a routine basis for dental therapy. |
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Indications for Mental Block.
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- buccal soft tissue anesthesia for procedures anterior to the mental foramen (biopsy)
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Contraindiations for Mental Block.
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- inflammation and infection in the area.
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Advantages of Mental Block.
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- high success rate
- easy/atraumatic |
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Disadvantaes of Mental Block
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hematoma (5%)
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Insertion of Mental Block
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mucobuccal fold anterior to foramen.
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Target of Mental Block.
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mental nerve as it exit sthe mental foramen
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Landmarks of Mental Block.
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- mandibular premolars
- mucobuccal fold |
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Failures of mental block.
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- rare
- miss the foramin |
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Failures of mental block.
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- rare
- miss the foramin |
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Complications of mental block
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Hematoma
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Complications of mental block
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Hematoma
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Technique of mental nerve block.
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- locate foramen with finger in mucobuccal fold
- insert needle anterior to foramen (5mm) - aspirate and inject |
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Technique of mental nerve block.
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- locate foramen with finger in mucobuccal fold
- insert needle anterior to foramen (5mm) - aspirate and inject |
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Indications for Incisive Nerve block.
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- dental procedures which require pulpal anesthesia of the mandibular anterior teeth
- used instead of bilateral inferior alveolar blocks for treatment limited to the anterior mandble. |
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Indications for Incisive Nerve block.
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- dental procedures which require pulpal anesthesia of the mandibular anterior teeth
- used instead of bilateral inferior alveolar blocks for treatment limited to the anterior mandble. |
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Contraindications for Incisive Nerve Block.
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- inflammation or infection
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Contraindications for Incisive Nerve Block.
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- inflammation or infection
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Incisive Nerve Block Advantages.
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- pulpal anesthesia of the anterior mandibular teeth without lingual anesthesia (uncomfortable)
- high success rate |
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Incisive Nerve Block Disadvantages.
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- no lingual anesthesia
- cross innervation from contralateral inferior alveiolar nerve may require additional suprperiosteal injections for pulpal anesthesia. |
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Incisive Nerve Block Insertion.
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- mucobuccal fold anterior to mucobuccal fold.
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Incisive NErve Block Target.
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- mental foramen (incisive nerve lies in this)
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Incisive Nerve Block Landmarks.
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- mandibular premolars
- mucobuccal fold |
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Incisive Nerve Block Failures.
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- inadequate volume of anesthetic
- inadequate pressureafte injection |
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Incisive Nerve Block Complications.
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- rare
- hematoma |
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Incisive Nerve Block Technique.
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- same as for mental block
- hold pressure for 2 minutes after injection to force anesthetic into formane nad reach the incisive nerve. |
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Mandibular Infiltration.
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- useful for supplemental anesthesia of anterior mandibular teeth when getting crossover fibers from contralateral inferior alveolar nerve
- thin cortical plate allows for suprperiosteal injection technique to be successful for mandibular incisors only in most patients - Technique exactly the same as for maxillary teet hwit hdeposition of anesthetic at root apex to block dental plexus. |
