Mandibular Injections Flashcards by Emily Caruso

What division of V3 is the Long Buccal Nerve located?

Anterior Division

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What 3 nerves are located in the Posterior Division of V3?

Lingual Nerve
Inferior Alveolar Nerve
Mental Nerve

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Quantity used for Conventional Mandibular Block?

1.8cc
All except 0.2cc in Posterior Zone
0.2cc in Anterior Zone (Long Buccal Nerve)

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Quantity used for Gow-Gates Mandibular Block?

1.8cc

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Quantity used for Uni-linear Mandibular Block?

1.8cc
3/4 initially, remainder while withdrawing

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Quantity used for Vazirani-Akinosi Mandibular Block?

1.8cc

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Quantity used for Mental Nerve Block?

1.0cc = 1/2 carpule
apply pressure, forces fluid into mental foramen

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Quantity used for Mylohyoid Nerve Block?

1.0cc
1/2

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Quantity used for C-3 Nerve Block?

0.9-1.0cc
1/2

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What is the most challenging area of the oro-facial complex to anesthetize?

Inferior Alveolar Nerve

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Why is local infiltration of anesthetic in the Inferior Alveolar Nerve area NOT effective?

Bone is more compact

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What is the initial path of the Inferior Alveolar Nerve?

Descends inferiorly and laterally across the pterygoid space

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Once the IAN crosses the Pterygoid Space what does it do?

Forms 2 branches:
- Lingual Nerve (anteriorly)
- Mylohyoid Nerve (posteriorly)
Enters into mandibular foramen

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What is the path of the IAN after it enters into the mandibular foramen?

Traverses beneath the roots of the mandibular teeth to the mental foramen
Divides into:
- Mental Nerve (exits the foramen)
- Terminal IAN Branches (remain in mandible)
  - Can cross the midline usually to opposite incisors, but can also extend to opposite mandibular foramen

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What is the path of the Lingual Nerve (4 parts)?

Descends inferiorly and medially between the ramus and medial pterygoid muscle
Runs anterior and slightly medial to the IAN
Runs just distal and medial to the 3rd Molar
Extends inferiorly to the tongue

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What does the Lingual Nerve provide sensation to?

Anterior 2/3 of tongue
FOM
Lingual gingiva

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What is the path of the Long Buccal Nerve?

Branches off Anterior V3
Descends parallel to the Lingual Nerve, and IAN
At Retromolar pad, swings laterally and fans up and out over the area of the buccal mucosa

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What does the Long Buccal Nerve provide sensory innervation to?

Buccal gingiva of Molar/PM area
Skin of cheek
NO innervation of the lip
Some overlap between terminal branches of LBN and Mental Nerve

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What nerves and their respective branches must be anesthetized for a Mandibular Block?

IAN
Lingual Nerve
Long Buccal Nerve

What is the posterior target area of the Conventional Mandibular Block?

Retromolar Triangle (moves in concert with the mandible)
- Pterygomandibular Raphe (medially)
- Anterior Border of the Ramus (laterally)
- Hamular Notch (superiorly)
Characterized by a dimple or depression found roughly in the center of the triangle

What can present a barrier to the posterior target zone of the Conventional Mandibular Block?

Lingula
- Pentrate the “dimple”
- Swing barrel toward the midline to reach posterior target zone

Where is the Anterior Target Zone of a Conventional Mandibular Block?

Anterior border of the Ramus

Where is penetration of the mucosa made in the anterior target area of a conventional mandibular block?

Distal and Buccal to the most distal molar tooth
Needle parallel to occlusal plane but buccal to teeth
Reposition needle if necessary (shallow tissue) = 45 deg angle/laterally
Insertion is made until bone is contacted (1-4mm)
Make sure bevel is buried

How does the Gow Gates differ from the Conventional?

Target zone significantly superior (2cm)
Longer onset = 5-10mins (vs. 3-5min)
Low aspiration rate

What Mand Block has successful anesthesia with bifid IAN and bifid mandbibular canals?

Gow Gates

What is the target area of Gow Gates?

Anteromedial side of condylar neck

Where is penetration of the mucosa for a Gow Gates?

* Needle placed just distal to max 2nd molar at the height of the ML cusp * syringe barrel aligned with the imaginary line between the intertragus notch and the corner of the mouth of the opposite side * Sit pt up right for 5 min with mouth open for 1-2min

How do you administer the Gow Gates?

* Insertion until bone is contacted (3/4 needle length)

If bone is not initially contacted with the Gow Gates what should you do?

Retract slightly and redirect needle by moving syringe barrel posteriorly (towards molars) = redirects needle anteriorly

What is the cause of missing bone in the Gow Gates?

Medial deflection of needle

Where is the target area of the Uni-linear Mandibular Block?

1 cm superior to Conventional Mandibular Block target

Where is penetration of the mucosa made for a Uni-Linear MB?

* 1 cm above dimple of Posterior Triangle (insert to 1/2 needle length) * Swing barrel to opposite side (C/PM area) and advance until bone is contacted * With draw 2mm and deposit 3/4 carpule * Slowly withdraw, depositing remaining carpule * Anesthesizes Lingual and Long Buccal

Where is the target area for Varizani-Akinosi Block?

**Medial** border of ramus (same height as uni-lateral)

When giving an Akinosi Block what should you be aware of?

Lateral flare of ramus

Where is the penetration of the mucosa for an Akinosi Block?

* Mouth is slightly closed * Syringe barrel is **parallel** to maxillary occlusal plane * **Bevel is AWAY from bone** * Needle is inserted at MGJ of Max 2nd molar and advanced in a **slightly lateral** direction * BONE IS NOT CONTACTED

Where is the target area for the Mental Nerve Block?

* mental foramen * between apices of 1st and 2nd PMs

Where is penetration of the mucosa made in a Mental Nerve Block?

* Depth of the vestibule * Just anterior or posterior to **neurovascular bundle** (palpate)

What is the insertion length for a Mental Nerve Block?

* Deep enough to bury the bevel (3-5mm) * Apply pressure on the area that has "ballooned"

What does the Mylohyoid Nerve provide sensory innervation to?

* Mand incisors * Mand molars - especially MB root of 1st molar

What is the indication for a Mylohyoid Block?

When mand incisors are still sensitive after a good solid mand block

Where is the target area for the Mylohyoid Block?

* lingual approach * just medial to the mand 2nd molar

Where is the penetration of the mucosa for a Mylohyoid Block?

* depth of the lingual vestibule * 45 deg angle to the long axis of the molar

What is the needle insertion length for the Mylohyoid Block?

1/4 - 1/3 needle length

What is the Indication for a C-3 Nerve Block?

* When mandibular molars are still sensitive after a good solid mandibular block * occurs in 50% of males with angular jaws

Where is the target area of the C-3 Nerve Block?

* buccal vestibule * lateral to the 2nd molar

Where is the penetration of the mucosa of the C-3 Block?

* depth of buccal vestibule * needle positioned **posteriorly** toward the **angle of the mandible**

What is the needle insertion length in the C-3 Block?

1/2