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Still confused about inferior alveolar nerve block?
There is all what you need to know.
Aim:
To deposit solution around the inferior alveolar nerve as it enters the mandibular foramen.
Steps:
- Ask patient to open mouth widely.
- Palpate the coronoid notch with your index finger.
- Move medially to palpate the internal oblique ridge.
- Identify the pterygomandibular raphe.
NOW YOR ARE ALMOST THERE
- Insertion point: pterygotemporal depression that is lateral to raphe.
- To identify insertion point you must first identify :
- Coronoid notch (greatest concavity on the anterior border of the ramus).
- Pterygomandibular raphe.
- Occlusal plane of the mandibular posterior teeth.
PTD: pterygotemporal depression, PMF: pterygomandibular fold, CN: coronoid notch,
GOT IT?!
- Dry the tissues and apply topical anesthesia for 1-2 minutes.
- Retract the cheek by a mirror.
- With a long needle, Insert form the contra-lateral premolar area 2/3 of the needle until gently touch bone.
- ASPIRATION IS MANDATORY.
- Deposit 1.5 ml of solution slowly (within 60-90 seconds).
- If you want to anesthetize the lingual nerve, withdraw the needle until have only 5 mm inside the tissue and deposit 0.3 ml.
- Withdraw the needle carefully.
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Errors:
- Too High injection lead to:
- Trismus due to injection into lateral pterygoid muscle.
- Numbness of the ear due to injection near to auriculotemporal nerve.
- Toxicity due to injection into the pterygoid plexus of veins.
- Too low injection leads to:
- Trismus due to injection into medial pterygoid muscle.
- Toxicity due to injection into the facial vein.
3 .Too low and deep injection leads to facial paralysis due to injection into the
substance of the parotid gland.[/vc_column_text][vc_column_text]
Clinical tips & tricks:
Don’t:
- Don’t deposit local anesthetic if bone is not contacted. The needle tip may be resting within the parotid gland near the facial nerve (cranial nerve VII).
- Don’t contact bone forcefully otherwise, pain is generated.
- Don’t ever never insert the needle up to the hub.
[/vc_column_text][vc_column_text]Ifs :
- If bone is contacted too soon (less than half the length of a long dental needle):
REASON: the needle tip is usually located too far anteriorly (laterally) on the ramus ,
To correct:
- Withdraw the needle slightly but do not remove it from the tissue.
- Bring the syringe barrel around toward the front of the mouth, over the canine or lateral incisor on the contralateral side.
- Redirect the needle until a more appropriate depth of insertion is obtained.
The needle tip is now located posteriorly in the mandibular sulcus.
- If bone is not contacted,
REASON: the needle tip is usually located too far posterior (medial).
To correct:
- Withdraw it slightly in tissue (leaving approximately one fourth its length in tissue) and reposition the syringe barrel more posteriorly (over the mandibular molars).
- Continue the insertion until contact with bone is made at an appropriate depth (20 to 25 mm).
- If Over insertion with no contact of bone.
REASON: The needle is usually posterior (medial) to the ramus.
To correct:
- Withdraw it slightly from the tissues
- reposition the syringe barrel over the premolars
Accessory innervation:
-
Cross the midline:
Nerves from the left side may cross the midline to enervate the right side and vice versa Counteracted by : Buccal & Lingual infiltration of the tooth in the other side.
- Cutaneous coli (C.C):
it is derived from the cervical plexus around C2 & C3 to supply the pulp of lower premolars Counteracted by : Buccal infiltration.
- Nerve to mylohyoid:
although it is a motor branch , it may carry some sensory fibers to the pulp of lower molar Counteracted by : Lingual infiltration.
Contraindications:
- Infection/inflammation at injection site.
- In patients at risk for self-injury (e.g. children – mentally handicapped), because they might keep biting either the lip or the tongue; causing hematoma.
Long buccal nerve block:
- Identify landmarks :
- Hard tissue landmark : anterior border of the ramus.
- Soft tissue landmark : mucus membrane distal and buccal to the last molar in the arch.
- Dry then apply topical
- Needle inserted 2-3 mm, parallel and at the level of the occlusal plane.
- When touch bone, deposit 0.3 mm of solution.
- withdraw the needle carefully.
Credits: Dr. Abdalla Jallal[/vc_column_text][stm_post_tags][stm_post_comments][/vc_column][/vc_row][/vc_section]