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Mandibular Injection Techniques Flashcards

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1
Q

proper hand position with the syringe?

A

palm down = poor control

palm up = better control

palm up and finger rest = BEST CONTROL

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2
Q

two soft tissue injections with mandibular anesthesia?

A

Mental

Buccal

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3
Q

4 mandibular block anesthesia

A
  1. IANB
  2. Incisive
  3. Gow-gates
  4. Vazirini - Alkinosis (closed mouth)
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4
Q

metal aesthesia is strictly what?

A

SOFT TISSUE

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5
Q 
#32 extraction with soft tissue flap, removal of bone, and sectioning tooth? 
Which LA technique to obtain adequate LA?
A
  1. IANB with long buccal
  2. Gow-gates
  3. Vazirini- akinosi
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6
Q

three techniques you can use to take out a wisdom tooth?

A
  1. IANB with long buccal
  2. Gow-gates
  3. Vazirini- akinosi
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7
Q

nerves anesthetized in an IANB?

A
  1. incisive
  2. mental

lingual is common

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8
Q

areas anesthetized in an IANB?

A

Mandibular teeth up to the midline

body of mandible, inferior part of the ramus

buccal mucoperiosteum, mucous membranes ANTERIOR to the mental foraemen (via mental nerve)

anterior 2/3 of the tongue and floor of oral cavity – lingual nerve

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9
Q

indication for giving an IANB

A
  1. procedures on multiple mandibular teeth
  2. when buccal soft tissue anesthesia is required anterior to the mental foramen
  3. when lingual soft tissue anesthesia is required
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10
Q

if pt. cannot open their mouth what can you not do?

A

Full IANB technique

- likely due to trismus

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11
Q

contraindications for IANB

A
  1. infection or actute inflammation in the area of the injection
  2. patients who might bite lips or tongue (very young child, handicaped patient)
  3. limitation to mouth opening *
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12
Q

Landmaks for preforming IANB?

A
  1. cornoid notch
  2. pterygomandibular raphe
  3. the occlusal plane of mandibular teeth
  4. contralateral premolars
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13
Q

position where you sit when giving an IANB on right side? left side?

A

right side = face patient and sit 8 oclock

left side - face same direction (face the patient) but sit at 10 oclock

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14
Q

pt. develops right sided facial paralysis. what happened?

A

facial nerve gets anesthetized

– needle goes beyond posterior border of the mandible into parotid

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15
Q

facial nerve controls muscles of the eye?

A

YES – so cant close the eye

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16
Q

opens the eye?

A

CN III

innervates LPS

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17
Q

CN VII action on eye and what it innervates

A

Innervates obicularis oris and is repsonsible for opening the eye

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18
Q

what happens if needle goes too deep in IANB?

A

could go into the parotid bed where cranial nerve 7 is and facial nerve paralysis

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19
Q

bone contact with IANB?

A

want to make sure we do not go too deep and into parotid bed– so if no contact likely had overinsertion and so you need to RETRACT AND REPOSITION LATERALLY

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20
Q

if you do not get adequate LA with an IANB what is likely the cause?

A
  1. too low (MOST COMMON)
  2. injection too far anterior
  3. ACCESSORY INNERVATION –
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21
Q

how to correct for accessory innervation in an IANB?

A

correct by

  1. lingual infiltrate
  2. PDL
  3. Inject lower for a bifid IAN
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22
Q

technique that has highest incidence of aspiration?

A

IANB (10-15%)

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23
Q

what is not anesthetized with an Incisve nerve block

A

the lingual soft tissues

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24
Q

incisive nerve block - explain general

Study These Flashcards
A

Terminal branch of the IAN

Travels in the incisve canal as a terminal branch of the IAN

(always anaesthetized with a successful IANB) – but this technique will not anesthetize the lingual soft tissue

25
incisive nerve block contraindication
infection or acute inflammation in the area of injection
26
advantages of the incisive nerve block
provides pulpal anesthesia without lingual anesethsia (could also be seen as a disadvanatge)
27
after successful IAN block - make your soft tissue incision and the patient feels pain, what happened?
forgot to anesthetize the long buccal nerve
28
what do you have to give with an IAN block when taking out a 3rd molar?
LONG BUCCAL NERVE BLOCK | - soft tissues and periosteium buccal tot he mandibular molar teeth
29
areas anesthetized with a buccal nerve block? what type is this? when is it used?
usually with a IANB when taking out 3rd molars is soft tissue -- basically up to first molar soft tissues and periosteium buccal tot he mandibular molar teeth
30
indications for a buccal nerve block?
when buccal soft tissue anesthesia is required for dental procedures in the mandibular molar region
31
contraindications for buccal nerve block
infection or acute inflammation in the area of injection
32
advantages to buccal nerve block
high success rate | technically easier
33
disadvantages for buccal nerve block
potential for pain if the needle contacts the periosteum
34
which is a 'true' mandibular nerve block?
Gow-gates
35
nerves anesthetized in a gow-gates block?
7 total 1. inferior alveolar 2. lingual 3. mylohyoid 4. mental 5. incisive 6. auriculotemporal 7. buccal (in 75% of pt's)
36
indications for gow-gates
similar to the IAN - need multiple procedures on mandibular teeth - conventional inferior alveolar nerve block is unsuccessful - lingual soft tissue anesthetic is needed - buccal soft tissue anesthesia needed from the third molar to the midline
37
difference in areas anesthetized with IANB vs. Gow gates
skin over the zygoma, posterior portion of the cheek, and temporal region can be anesthetized in the gow-gates method via the auriculotemporal nerve ****
38
landmarks for Gow-gates
1. mucous membrane on mesial of the ramus 2. line from the intertragic notch to the corner of the mouth 3. target area = condylar neck just below the insertion of the lateral pterygoid muscle 4. height = just below the maxillary ML cusp of the 2nd molar 5. site = penetrate just distal to the maxillary 2nd molar
39
area of insertion for gow-gates
mucous membrane on mesial of the ramus
40
target area for gow-gates
condylar neck just below the insertion of the lateral pterygoid muscle
41
site of pentration in gow-gates
just distal to the maxillary 2nd molar
42
contraindications for gow-gates
1. infection or acute inflammation in the area of injection 2. patients who might bite their lip or tongue 3. patietns who are unable to open their mouth wide
43
advantages of gow-gate
requires only one injection (vs. IANB with the long buccal) | - provides succesful anesthesia where a bifid IAN and bifid manibular canals are present
44
epidural hematoma from what?
tearing middle meningeal artery if fracture the pterion of skull
45
how could solution gain access to the cavernous sinus?
with reference to Gow-gates block origins of the middle meningeal and inferior alveolar arteris are in close porximity to each other -so by way of the arterial system, solution may gain access to the cavernous sinus *** middle meningeal and inferior alveolar aeteries -- so by way of arterial system if the LA soliution gets into these arteries
46
temporary paralysis of CN III, IV, VI?
with reference to Gow-gates block origins of the middle meningeal and inferior alveolar arteris are in close porximity to each other -so by way of the arterial system, solution may gain access to the cavernous sinus
47
complications of Goq-gates
hematoma trismus - rate temporary paralysis of CN III, IV, VI
48
a pt. cannot open their mouth - which local anesthetic technique would you perform?
Vazirani-akinosi closed mouth block
49
Vazirani-akinosi block - which nerves anesthetized?
``` Inferior alveolar incisive mental lingual mylohyoid ```
50
areas anesthetized with Vazirani-akinosi closed mouth block
mandibular teeth to midline body of the mandible and inferior portion of the ramus buccal mucoperiosteum and mucous membrane in front of the mental foramen anterior 2/3 of the tongue an the floor of the mouth lingual soft tissue and periosteum
51
indications to perform Vazirani-akinosi closed mouth block
1. limited ability in mandibualr opening | 2 .inability to visualize the IANB landmarks
52
contraindications to Vazirani-akinosi closed mouth block
1. infection, acute inflammation 2. patients who might bite themselves 3. inability to visualize or gain access to lingual aspect of the ramus
53
area of insertion for Vazirani-akinosi closed mouth block
1. MANDIBULAR MEDIAL SOFT TISSUE 2. adjacent to maxillary tuberosity 3. height of muco-gingival junction adjacent to 3rd molar
54
disadvanatges to Vazirani-akinosi closed mouth block
difficult to visualize the path of the needle and the depth of insertion no bony contact; depth of penetration somewhat arbitrary potentially traumatic if needle is too close to periosteum
55
indication for mental nerve block
soft tissue biopsies and sutering
56
area anesthetized in mental nerve block
buccal mucous membrane anterior to the mental foramen to the midline and the skin of the lower lip
57
triangulate what 3 hard tissue landmarks for IANB? what is at the center?
1. coronoid notch 2. mandibular angle 3. posterior condyle center = approx. location of the mandibular foramen
58
triangulate what 3 soft tissue landmarks for IANB? what is at the center?
1. buccal tissues on mandible 2. lateral pterygoid 3. PMR - medial pterygoid center= approx. location of the mandibular foramen

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