4. Anatomy and Techniques for Mandibular Injections

Question 1

Mandibular Division

1. Undivided nerve
   a. Nervus ____
   b. Nerve to the ____ muscle 2

. Divided nerve

a. Anterior division
1) Nerve to ____ m. 2) Nerve to the ____ muscle 3) Nerve to the ____ muscle 4) ____ nerve (long buccal n.)

Answer 1

spinosus
medial pterygoid

lateral pterygoid
masseter
temporal
buccal

Question 2

Mandibular Division

b. Posterior division
1) ____ nerve
2) Lingual nerve
3) ____ nerve
4) ____ nerve: dental branches
5) ____ branch: dental branches
6) ____ nerve

Answer 2

auriculotemporal
mylohyioid
inferior alveolar
incisive
mental

Question 3

Sensory Root (V3)
1. Sensory Root 

a. skin of
1) ____ region
2) Auricula
3) ____ means
4) Cheek
5) ____
6) Lower part of face (chin)

Answer 3

temporal
external auditory
lower lip

Question 4

Sensory Root (V3)

b. Mucous membrane of
1) ____
2) ____ (anterior two thirds)
3) ____ cells
c. Mandibular teeth and periodontal
tissues
d. Bone of the ____
e. Temporomandibular joint
f. ____ gland

Answer 4

cheek
tongue
mastoid
mandible
parotid

Question 5

Innervation of the Craniomandibular Joint
Trigeminal

Motor
\_\_\_\_
Anterior digastric masseter
\_\_\_\_
Medical pterygoid 
\_\_\_\_

Sensory
____
inferior alveolar
____

Answer 5

mylohyoid
posterior deep temporal
lateral pterygoid

buccal
auriculotemporal

Question 6

Atraumatic Injection Technique

1. Use a ____ sharp needle.
2. Check the flow of local anesthetic solution.
3. Determine whether to ____ the anesthetic cartridge or syringe.
4. Position the patient.
5. ____ the tissue.
6. Apply topical antiseptic (optional).
   7a. Apply topical anesthetic.
   7b. ____ with the patient.
7. Establish a firm ____ rest.
8. Make the tissue taut.
9. Keep the syringe out of the patient’s line of ____

Answer 6

sterilized
warm
dry
communicate
hand
sight

Question 7

11a. Insert the needle into the mucosa.
11b. Watch and communicate with the patient.
12. Inject several drops of local anesthetic solution (optional).
13. Slowly advance the needle toward the target.
14. Deposit several ____ of local anesthetic
before touching the periosteum.
15. Aspirate.
16a. Slowly deposit the local anesthetic solution.
16b. Communicate with the patient.
17. ____ withdraw the syringe. Cap the needle and discard.
18. Observe the patient after the injection.
19. Record the injection on the patient’s chart.

Answer 7

drops

slowly

Question 8

Inferior alveolar nerve block

Nerves anesthetized

1. Inferior alveolar a branch of the ____ division of the mandibular nerve
2. ____ } Terminal branches of
3. ____ } the inferior alveolar
4. ____ (quite commonly)

Answer 8

posterior
incisive
mental
lingual

Question 9

Inferior Alveolar Nerve Block
Areas anesthetized

1. ____ teeth to the midline
2. Body of the ____, inferior portion of the ramus
3. Buccal mucoperiosteum, mucous membrane anterior to the ____ (mental nerve)
4. ____ of the tongue and the floor of the oral cavity (lingual
   nerve)
5. ____ soft tissues and periosteum (lingual nerve)

Answer 9

mandibular
mandible
mandibular first molar
anterior two hirds
lingual

Question 10

GOW-GATES MANDIBULAR NERVE BLOCK
 Entire distribution of ____

 \_\_\_\_
 Mental
 \_\_\_\_
 Incisive
 \_\_\_\_
 Mylohyoid
 \_\_\_\_

Answer 10

V3
inferior alveolar
long buccal
lingual
auriculotemporal

Question 11

GOW – GATES MANDIBULAR NERVE BLOCK (I)

 Higher success rate than conventional ____ block

Answer 11

interior alveolar

Question 12

GOW – GATES BLOCK (II)
 Contact bone at ____
(25mm depth)
 ____ (1 mm) – aspirate - inject

Answer 12

neck of condyle

retract

Question 13

GOW-GATES Technique
Areas anesthetized
1. ____ teeth to the midline
2. Buccal mucoperiosteum and mucous
membranes on the side of the injection
3. ____ of the tongue and the floor of the oral cavity
4. Lingual soft tissue and periosteum
5. Body of the ____, inferior portion of the ramus
6. Skin over the ____, posterior portion of the cheek, and ____ regions

Answer 13

mandibular
anterior two thirds
mandible
zygoma
temproal

Question 14

GOW-GATES Technique

Nerves anesthetized

1. ____
2. Mental
3. ____
4. Lingual
5. ____
6. Auriculotemporal
7. ____ (in 75% of patients)

Answer 14

inferior alveolar
incisive
mylohyoid
buccal

Question 15

Akinosi Mandibular Block (Closed Mouth)

 Indicated in limited ____ opening (not in face of infection)
 Height of injection between ____ and ____ technique

Answer 15

mandibular
inferior alveolar
Gow-Gates

Question 16

Akinosi Technique

Nerves anesthetized

1. ____
2. Incisive
3. ____
4. Lingual
5. ____

Answer 16

inferior alveolar
mental
mylohyoid

Question 17

Akinosi Technique

Areas anesthetized
1. ____ teeth to the midline
2. Body of the ____ and
inferior portion of the ramus
3. Buccal mucoperiosteum and mucous membrane in front of the mental foramen
4. ____ of the tongue and the floor of the oral cavity (lingual nerve)
5. Lingual ____ and periosteum (lingual nerve)

Answer 17

mandibular
mandible
anterior two thirds
soft tissue

Question 18

Buccal Nerve Block
Nerve anesthetized ____ (a branch of the ____ division of the mandibular)

Area anesthetized Soft tissues and periosteum ____ to the mandibular molar teeth

Answer 18

buccal
anterior
buccal

Question 19

Buccal Nerve Block
 May be anesthetized with ____ block
 Innervate soft tissue of ____
 Target area – as nerve passes over ____

Answer 19

mandibular
mandibular molars
anterior border of ramus

Question 20

Mental Nerve Block

Nerve anesthetized ____, a terminal branch of ____ alveolar

Areas anesthetized Buccal mucous membranes anterior to the ____ (around the second premolar) to the ____ and skin of the lower lip and chin

Answer 20

mental
inferior

mental foramen
midline

Question 21

Mental Nerve Block

 Good for facial ____
 Foramen at apex of ____
 Can access ____ nerve – risk ____ and direct nerve injury

Answer 21

lacerations
second bicuspid
incisive
heamtoma

Question 22

Complications
•\_\_\_\_
•Trismus
•Transient \_\_\_\_ paralysis •Nerve injury
•\_\_\_\_
•Pain

Answer 22

hematoma
facial
infection