Mandibular Injection Techniques Flashcards
1
Q
where is the buccal nerve located
A
between lateral pterygoid heads
2
Q
what does the buccal nerve supply sensory innervation to
A
- cheek area
- molar buccal gingiva
3
Q
what type of needle is used with buccal nerve block
A
25 gauge long needle
4
Q
what are the steps to the buccal nerve block
A
- stretch tissue
- contact periosteum
5
Q
what tissues are anesthetized in the buccal nerve block
A
- gingiva buccal to molars
- retromolar pad mucosa
- buccal mucosa in molar area
- no hard tissues anesthetized
6
Q
when is the buccal nerve block indicated
A
when buccal soft tissue anesthesia is required
7
Q
what are the advantages of the buccal nerve block
A
- high success rate
- easy injection to administer
- atraumatic
8
Q
what is the posterior division of the mandibular nerve
A
- primarily sensory
- auriculotemporal nerve
- lingual nerve
- inferior alveolar nerve
- mylohyoid nerve
9
Q
what areas are innervated by the auriculotemporal nerve
A
- skin over areas suppled by VII
- skin over helix and tragus of ear
- skin of external auditory meatus
- posterior part of TMJ
- skin over temporal area
10
Q
the lingual nerve is the ______ of the posterior division
A
second branch
11
Q
what does the lingual nerve innervate
A
-the anterior 2/3 of tongue
-lingual mucosa
12
Q
what is the lingual nerve blocked with
A
- inferior alveolar block
- mandibular block
- gow-gates mandibular block
- vazirana akinosi block
- infiltration in lingual sulcus
13
Q
what is the largest branch of the posterior division
A
inferior alveolar nerve
14
Q
what ligament is associated with the inferior alveolar nerve
A
sphenomandibular ligament
15
Q
what does the inferior alveolar nerve exit through
A
the mandibular foramen
16
Q
the mandibular foramen is at the level of:
A
the coronoid notch
17
Q
where do you inject for inferior alveolar nerve block
A
- at level of coronoid notch
- directed across arch
18
Q
what muscle does the syringe penetrate for the inferior alveolar nerve block
A
buccinator
19
Q
inferior alveolar nerve block penetration lateral to:
A
pterygomandibular raphe
20
Q
where do you inject for the inferior alveolar nerve block
A
between raphe and notch
21
Q
what are the steps for inferior alveolar nerve block
A
- dry the site
- apply topical anesthetic
-wait one-two minutes
-finger on notch to retract cheek and determine height of injection - aspirate, inject 1.5mL over 60 sec
- insert ~25mm to contact bone
- withdraw halfway, deposit 0.1mL at lingual nerve
22
Q
what nerves are anesthetized with the inferior alveolar nerve block
A
- inferior alveolar
- incisive
- mental
- lingual
23
Q
when is the inferior alveolar nerve block indicated
A
- wide area requires anesthesia
- buccal tissue anesthesia is needed
- lingual soft tissue anesthesia is needed
24
Q
when is the inferior alveolar nerve block contraindicated
A
- infection in area
- acute inflammation in area
- patient a potential lip biter
25
what are the advatnages to the inferior alveolar nerve block
- provides wide area of anesthesia
- minimizes anesthetic dose
26
what are the disadvantages to the inferior alveolar nerve block
- wide area anesthetized
- unsuccessful in 15-20%
- inconsistent oral landmarks
-10-15% positive aspiration
27
what are the alternatives to the inferior alveolar nerve block
- mental nerve block
- incisive nerve block
- gow-gates block
- vazirani-akinosi block
- intraosseous or intraseptal injection
28
the mental nerve is the ____ of the inferior alveolar nerve
terminal branch
29
what are the steps to the mental nerve block
- palpate the mental foramen
- determine site of injection
- dry the area and apply topical
- orient needle bevel facing bone
- insert into tissue over foramen
- deposite 0.6mL over 20 seconds
30
what areas are anesthetized with the mental nerve block
- mucosa anterior to foramen
- skin of the lower lip
- chin
31
what are the indications for the mental nerve block
- soft tissue anesthesia
- suturing lip lacerations
- biospies of lip tissue
32
what are the contraindications for the mental nerve block
- infection in the area
- acute inflammation
33
what are the advantages to the mental nerve block
- high success rate
- technically easy
- usually entirely atraumatic
34
what are the disadvantages to the mental nerve block
- hematoma
- positive aspiration 5.7%
35
incisive nerve is ____ of inferior alveolar nerve
terminal branch
36
what does the incisive nerve supply
incisors, canine, premolars
37
what are the steps for the incisive nerve block
- identical to mental block with pressure maintained 2 minutes
- trans papilla injection for lingual anesthesia
38
what areas are anesthetized with the incisive nerve block
- mucosa on buccal
- lower lip
- skin of the chin
- premolars, canines, incisors
39
what are the indications for the incisive nerve block
- procedures on anterior teeth
- when inferior alveolar block is not indicated
- to avoid bilateral mandibular blocks
40
what are the contraindications to the incisive nerve block
- infection
- acute inflammation
41
what are the advantages for the incisive nerve block
- provides pulpal and hard tissue anesthesia without lingual anesthesia
- high success rate
42
what are the disadvantages to the incisive nerve block
- no lingual anesthesia
- may be sensory overlap at midline (rare)
- positive aspiration 5.7%
43
what is the Gow-Gates nerve block
- true mandibular nerve block
44
what does the needle contact in the gow gates nerve block
the neck of condyle
45
what are the 2 extra oral landmarks for the gow gates nerve block
- corner of mouth
- intertragic notch
46
the needle puncture in the gow gates nerve block is dictated by:
intra oral landmarks
47
what are the steps to the gow gates nerve block
- pt opens wide and the condyle moves forward
- advance until bone contacted
- withdraw 1mm, aspirate, inject 1.8mL
48
what nerves are anesthetized with the gow gates nerve block
- inferior alveolar
- lingual
- mylohyoid
-auriculotemporal
- buccal (in75%)
49
when is the gow gates nerve block indicated
- multiple procedures
- buccal anesthesia required
- lingual anesthesia required
- minimal dose of anesthetic
50
what are the contraindications for the gow gates nerve block
- infection in area
- inflammation in area
- potential lip biter
- restricted mouth opening
51
what are the advantages to the gow gates nerve block
- 95-99% success rate
- single injection
- minimal aspiration rate
- few complications
- blocks mylohyoid nerve
52
what are the disadvantages to the gow gates nerve block
- longer onset >5 minutes
- no intraoral landmarks
- variable buccal nerve anesthesia
- requires patient to open mouth widely
- variable location of soft tissue landmarks
- requires visualization of both intraoral and extraoral soft tissue landmarks
53
what is another name for the vazirani-akinosi nerve block
closed mouth
54
what is the height of injection for the vazirani-akinosi nerve block
- maxillary muco gingival line
55
vazirani-akinosi nerve block is ____ to ramus
directly parallel
56
what are the steps to the vazirani akinosi nerve block
- insert to 25mm depth
- aspirate, inject 1.5 to 1.8mL
57
what nerves are anesthetized with the vazirani akinosi nerve block
- inferior alveolar
- lingual
- mylohyoid
58
what are the indications for the vazirani akinosi nerve block
- limited mouth opening
- multiple procedures planned
- landmarks poorly visible for other injections
59
when is vazirani akinosi nerve block contraindicated
- infection in area
- inflammation in area
- potential lip biter
- inadequate access
60
what are the advantages to the vazirani akinosi nerve block
- relatively atraumatic
- no need to open mouth
- aspiration rate less than 10%
- high success rate
- relatively simple
- blocks mylohyoid nerve
61
what are the disadvantages to the vazirani akinosi nerve block
- difficult visualization
- no bony contact
- arbitrary insertion depth
- variable buccal nerve anesthesia
- improper angulation may lead to maxillary anesthesia
62
