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intro to OS and pain management > mandibular injections > Flashcards

mandibular injections Flashcards

1
Q

buccal nn location btwn what mm?

A

Buccal Nerve
Between Lateral Pterygoid Heads

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2
Q

buccal nn functions

A

Sensory to Cheek Area
Sensory to Molar Buccal Gingiva

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3
Q

buccal nn injection site

A

anterior aspect of the ramus/lateral

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4
Q

buccal nn block needle

A

Injection – 25 Gauge Long Needle

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5
Q

what to do with tissue in buccal nn block

A

stretch tissue

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6
Q

what should you contact with needle in buccal nn block

A

periosteum

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7
Q

Buccal Nerve Block
Tissues Anesthetized

A

*Gingiva buccal to molars
*Retromolar pad mucosa
*Buccal mucosa in molar area
*NO hard tissues anesthetized

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8
Q

Buccal Nerve Block
Indications

A

*When buccal soft tissue
anesthesia is required

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9
Q

Buccal Nerve Block
Advantages

A

*High success rate
*Easy injection to administer
*Atraumatic

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10
Q

Mandibular Nerve
Posterior Division branches

A

Primarily sensory
*Auriculotemporal nerve
*Lingual nerve
*Inferior alveolar nerve
*Mylohyoid nerve

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11
Q

Auriculotemporal Nerve
Areas Innervated

A

*Skin over areas supplied by VII
*Skin over helix and tragus of ear
*Skin of external auditory meatus
*Posterior part of TMJ
*Skin over temporal area

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12
Q

Auriculotemporal Nerve location

A
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13
Q

second branch of posterior division of man nn

A

lingual nn

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14
Q

Lingual NerveInnervates:

A

Innervates Anterior 2/3 of Tongue
nnervates Lingual Mucosa

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15
Q

Lingual Nerve Blocked With:

A

*Inferior Alveolar Block
*Mandibular Block
*Gow-Gates Mandibular Block
*Vazirani-Akinosi Block
*Infiltration in lingual sulcus

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16
Q

what block is this?

A

lingual infiltration

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17
Q

Largest Branch of Posterior Division

A

IA

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18
Q

foramen and ligament associated with IA

A
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19
Q

what landmark is used for typical IA blocks

A

coronoid notch, want needle injected at this level from across the arch at contralateral PM region

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20
Q

when doing an IA block what mm is penetrated

A

buccinator

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21
Q

Inferior Alveolar Nerve Block
Penetration Lateral to:

A

Lateral to Pterygomandibular Raphe

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22
Q

Inferior Alveolar Nerve Block
Site Between what landmarks?

A

Raphe and Notch

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23
Q

steps to IA block

A
  1. dry site
  2. topical anesthetic, wait 1-2min
  3. Finger on Notch Retracts Cheek and
    Determines Height of Injection
  4. Note Site of Needle Insertion
  5. Barrel of Syringe in Corner of Mouth
  6. Insert~25mm to Contact Bone
  7. Aspirate, Inject 1.5 ml over 60 Sec.
  8. Withdraw Halfway, Deposit 0.1 ml at
    Lingual Nerve
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24
Q

Inferior Alveolar Nerve Block
Nerves Anesthetized

A

*Inferior alveolar
*Incisive
*Mental
*Lingual (usually)

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25
Inferior Alveolar Nerve Block Indications
*Wide area requires anesthesia *Buccal tissue anesthesia is needed *Lingual soft tissue anesthesia is needed
26
Inferior Alveolar Nerve Block Contraindications
*Infection in area *Acute inflammation in area *Patient a potential lip-biter
27
Inferior Alveolar Nerve Block Advantages
*Provides wide area of anesthesia *Minimizes anesthetic dose
28
Inferior Alveolar Nerve Block Disadvantages
*Wide area anesthetized *Unsuccessful in 15 to 20% *Inconsistent oral landmarks *10-15% positive aspiration
29
Inferior Alveolar Nerve Block Alternatives
*Mental nerve block *Incisive nerve block *Gow-Gates block *Vazirani-Akinosi block *Intraosseous or intraseptal injection
30
Terminal Branch of Inferior Alveolar
mental nn
31
locating the mental nn
palpate the foramen/radio
32
injection site of mental block
depth of vestibule
33
steps to mental block
1. dry area 2. topical 3. orient needle (bevel to bone) 4. Insert into Tissue Over Foramen Deposit 0.6 ml over 20 seconds.
34
Mental Nerve Block Areas Anesthetized
*Mucosa anterior to foramen *Skin of the lower lip *Chin
35
Mental Nerve Block Indications
*Soft tissue anesthesia *Suturing lip lacerations *Biopsies of lip tissue
36
Mental Nerve Block Contraindications
*Infection in the area *Acute inflammation
37
Mental Nerve Block Advantages
*High success rate *Technically easy *Usually entirely atraumatic
38
Mental Nerve Block Disadvantages
*Hematoma *Positive aspiration 5.7 %
39
Incisive Nerve is the terminal branch of?
Terminal Branch of Inferior Alveolar
40
Incisive Nerve Supplies:
Incisors, Canine, Premolar(s)
41
incisive nn cross inn
possible in the ant region
42
Incisive Nerve Block technique
Identical to Mental Block With Pressure Maintained 2 Minutes
43
lingual anestheisa for maxillary anteriors
Trans-Papilla Injection for Lingual Anesthesia
44
Incisive Nerve Block Areas Anesthetized
*Mucosa on buccal *Lower Lip *Skin of the chin *Premolars, canines, incisors
45
Incisive Nerve Block Indications
*Procedures on anterior teeth *When inferior alveolar block is not indicated *To avoid bilateral mandibular blocks
46
Incisive Nerve Block Contraindications
*Infection *Acute inflammation
47
Incisive Nerve Block Advantages
*Provides pulpal and hard tissue anesthesia without lingual anesthesia *High success rate
48
Incisive Nerve Block Disadvantages
*No lingual anesthesia *May be sensory overlap at midline (rare) *Positive aspiration 5.7 %
49
Gow-Gates Nerve Block
target at condylar level for true Mandibular Nerve Block
50
Gow-Gates Nerve Block Needle Contacts:
Gow-Gates Nerve Block Needle Contacts Neck of Condyle
51
GG extraoral landmarks
corner of mouth and intertragic notch
52
mouth opening with GG
wide open causing translation of condyle
53
Gow-Gates Nerve Block Needle Puncture Point Dictated by:
Gow-Gates Nerve Block Needle Puncture Point Dictated by Intra-oral Landmarks
54
GG advance needle until:
bone contacted
55
once bone contacted with GG what should you do?
Withdraw 1 mm, Aspirate, Inject 1.8 ml
56
Gow-Gates Nerve Block Nerves Anesthetized
*Inferior Alveolar *Lingual *Mylohyoid *Auricolotemporal *Buccal (in 75 %)
57
Gow-Gates Nerve Block Indications
*Multiple procedures *Buccal anesthesia required *Lingual anesthesia required *Minimal dose of anesthetic
58
Gow-Gates Nerve Block Contraindications
*Infection in area *Inflammation in area *Potential lip-biter *Restricted mouth opening
59
Gow-Gates Nerve Block Advantages
*95-99% success rate ! *Single injection *Minimal aspiration rate *Few complications
60
Gow-Gates Nerve Block Disadvantages
*Longer onset, >5 minutes) *No intraoral landmarks
61
Vazirani-Akinosi Nerve Block used how?
closed mouth
62
Vazirani-Akinosi Nerve Block Height of Injection
between GG and IA block
63
intraoral landmark for Vazirani-Akinosi Nerve Block
MGJ
64
Vazirani-Akinosi Nerve Block path of insertion
directly parallel to ramus and on medial aspect
65
Vazirani-Akinosi Nerve Block needle insertion depth aspirate? inject how much?
Insert to 25 mm Depth Aspirate, Inject 1.5 to 1.8 ml
66
Vazirani-Akinosi Nerve Block Nerves Anesthetized
*Inferior Alveolar *Lingual *Mylohyoid
67
Vazirani-Akinosi Nerve Block Indications
*Limited mouth opening *Multiple procedures planned *Landmarks poorly visible for other injections
68
Vazirani-Akinosi Nerve Block Contraindications
*Infection in area *Inflammation in area *Potential lip-biter *Inadequate access
69
Vazirani-Akinosi Nerve Block Advantages
*Relatively atraumatic *No need to open mouth *Aspiration rate <10 %
70
Vazirani-Akinosi Nerve Block Disadvantages
*Difficult visualization *No bony contact *Arbitrary insertion depth

intro to OS and pain management (8 decks)

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