Mandibular Anesthesia

Question 1

What nerve provides pulpal innervation to the mandibular molars and premolars?

Answer 1

Inferior alveolar nerve.

Question 2

What nerve provides pulpal innervation to the incisors and canines?

Answer 2

Incisive nerve

Question 3

What does the mental nerve supply?

Answer 3

Buccal mucosal innervation to mandibular incisors, canines and premolars

Question 4

What nerve provides mucosal innervation to the molars buccally?

Answer 4

Long buccal nerve.

Question 5

What nerve provides mandibular lingual soft tissue innervation?

Answer 5

Lingual nerve

Question 6

What are 2 names for the IANB technique used?

Answer 6

Halstead approach/ direct technique.

Question 7

What is in front of the mandibular foramen and may cause trouble when providing IANB?

Answer 7

Lingula

Question 8

What space are we injecting into in an IANB?

Answer 8

Pterygomandibular space.

Question 9

What are the boundaries (5) of the pterygomandibular space?

Answer 9

• Lateral: ramus
• Medial: medial pterygoid.
• Posterior: Parotid and facial nerve.
• Anterior: buccinator
• Superior: lateral pterygoid

Question 10

What is important about the posterior border of the pterygomandibular space during IANB?

Answer 10

• The pterygomandibular space is bordered posteriorly by the parotid gland and its capsule which contains the facial nerve. If you deposit anesthetic solution too far posterior and into that capsule you can affect the facial nerve (which includes the motor function). This can cause drooping of the muscles of facial expression on that side.

Question 11

What happens if you inject anesthetic into the facial nerve during IANB?

Answer 11

DROOPING OF THE MUSCLES OF FACIAL EXPRESSION ON THAT SIDE.

Question 12

What is a sign that IANB has worked? What has it anesthetized?

Answer 12

NUMB LOWER LIP on the side.

HAs anesthetizes IAN and everything downstream it including MENTAL NERVE.

Question 13

What anatomical structure can be a barrier to an effective IANB?

Answer 13

sphenomandibular ligament

Question 14

What landmarks do we use during IANB?

Answer 14

Pterygomandibular raphe

Thumb on coronoid notch/ external oblique ridge/ ascending ramus

Question 15

What are the attachments of the pterygomandibular raphe?

Answer 15

this goes from the PTERYGOID HAMULUS superiorly which is medial to the maxillary tuberosity or the last molar) and comes down just on the lingual side of the mandible.

Question 16

Why do we go halfway up our thumbnail in IANB?

Answer 16

halfway up your thumbnail (roughly a centimeter above the occlusal plane, hence we are putting the needle in about 1cm above the mandibular foramen, making it more likely that we will catch that nerve before it enters the foramen

Question 17

What other nerve can be anesthetize when giving IANB? How?

Answer 17

Give IANB, WITHDRAW NEEDLE 1-1.5CM then GIVE REMAINING OF CARTRIDGE TO ANESTHETIZE THE LINGUAL NERVE.

Question 18

Buccal nerve block?

Answer 18

• The long buccal nerve is located much more superiorly to the lingual and inferior alveolar nerves and runs into the buccal mucosa.
• Inject towards the lateral border of the ramus of the mandible, across the third molar.

Question 19

What needle is used for buccal nerve block?

Answer 19

• Only need SHORT NEEDLE as not going into a space/ hitting bone right away.

Question 20

How is a mental nerve block done? What needle is used?

Answer 20

Inject between the apices of the lower 4 and 5.

SHORT NEEDLE.

Question 21

How are lower incisors anesthetized most reliably?

Answer 21

• Block not reliable due to CROSSOVER.
• Only B or L –> 50% success rate.
• Split dose (B and L) –> 90% success.

SPLITTING DOSE AFFECTS SUCCESS RATE.