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Techniques of Mandibular Anesthesia

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various techniques of mandibular anaesthesia in short and an easy way

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Techniques of Mandibular Anesthesia

Mandibular Nerve BlocksInferior alveolarMental BuccalLingualGow-GatesVazirani-Akinosi

Inferior Alveolar Nerve BlockNerves anesthetized

Inferior Alveolar Mental Incisive Lingual

Inferior Alveolar Nerve BlockAreas Anesthetized

Mandibular teeth to midline Body of mandible, inferior portion of the

ramus Buccal mucosa anterior to mental foramen Anterior 2/3 tongue & floor of mouth Lingual soft tissue and periosteum

Inferior Alveolar Nerve BlockIndications1. Procedures on multiple mandibular teeth in one

quadrant

2. When Buccal soft tissue anesthesia is necessary

3. When Lingual soft tissue anesthesiais necessary

Inferior Alveolar Nerve Block Contraindications

1. Infection/inflammation at injection site

2. Patients at risk for self injury (eg. Children,- lip or tongue biting )

Inferior Alveolar Nerve BlockAlternatives

Mental nerve block

Incisive nerve block

Anterior infiltration

Inferior Alveolar Nerve BlockAlternatives (cont.)

Periodontal ligament injection (PDL)

Gow Gates Block

Vazirani – Akinosi Block

Inferior Alveolar Nerve BlockTechnique Apply topical

Area of insertion: Mucus membrane on the medial side of the

ramus, -At the intersection of two lines-Horizontal- representing height of injectionVertical- representing anteroposterior plane of injection

Inferior Alveolar Nerve Block Target Area Inferior alveolar nerve, near mandibular foramen Landmarks Coronoid notch Pterygomandibular raphe Occlusal plane of the mandibular posterior teeth

Procedure-

Inferior Alveolar Nerve BlockPrecautions

Do not inject if bone not contacted Avoid forceful bone contact

Inferior Alveolar Nerve BlockFailure of Anesthesia Injection too low Injection too anterior Accessory innervation -Mylohyoid nerve -contralateral Incisive nerve innervation

Inferior Alveolar Nerve BlockComplications Hematoma

Trismus

Transient Facial paralysis

Buccal Nerve BlockAnterior branch of Mandibular nerve (V3)

Provides buccal soft tissue anesthesia, adjacent to mandibular molars

Not required for most restorative procedures

Area Aanesthetized- soft tisue& periosteum buccal to mandibular molars

Buccal Nerve BlockIndications When Anesthesia is required – in the

mandibular molar region

Contraindications Infection/inflammation at injection site

Nerve Anesthetized- Buccal

Buccal Nerve BlockAdvantages Technically easy High success rate

Disadvantages Discomfort

Buccal Nerve BlockAlternatives Buccal infiltration Gow-Gates PDL injection Intraseptal injection Vazirani - Akinosi

Buccal Nerve BlockTechnique Apply topical Insertion distal and buccal to last molar

Target Area - Long Buccal nerve,-as it passes along anterior border of ramus

Area of insertion-Mucosa adjacent to most distal molar-(distal & bucally)

Buccal Nerve BlockLandmarks Mandibular molars

Mucobuccal fold

Procedure-

•Complications- Hematoma

Mental Nerve BlockTerminal branch of IAN as it exits mental

foramen

Provides sensory innervation to buccal soft tissue anterior to mental foramen, lip and chin

Mental Nerve BlockIndication When buccal soft tissue anesthesia is necessary

for procedures in the mandible anterior to mental foramen

Contraindication Infection/inflammation at injection site

Mental Nerve BlockAdvantages Easy, high success rate Usually atraumatic

Disadvantage Hematoma

Mental Nerve BlockAlternatives Local infiltration Intraseptal injection Inferior alveolar nerve block Gow Gates

Mental Nerve Block

Complications Few Hematoma

Incisive Nerve BlockTerminal branch of IAN      Originates in mental foramen and proceeds

anteriorly

Good for bilateral anterior anesthesia           Not effective for anterior lingual anesthesia  

Incisive Nerve BlockNerves anesthetized Incisive

Mental

Incisive Nerve BlockAreas Anesthetized Mandibular labial mucous membranes

Lower lip / skin of chin

Incisor, cuspid and bicuspid teeth

Incisive Nerve BlockIndication Anesthesia of tissue required anterior to mental

foramen

Contraindication Infection/inflammation at injection site

Incisive Nerve BlockAdvantages High success rate Pulpal anesthesia w/o lingual anesthesiaDisadvantages Lack of lingual or midline anesthesiaComplications Hematoma

Gow-Gates TechniqueThe Gow-Gates technique is useful alternative to

the inferior alveolar nerve block it is often used when the latter fails to provide

adequate anesthesia. Advantages of this technique versus the inferior

alveolar technique are its low failure rate and low incidence of positive aspiration.

The Gow-Gates technique anesthetizes the auriculotemporal, inferior alveolar, buccal, mental, incisive, mylohyoid and lingual nerves.

Contraindications to this procedure include acute inflammation and infection over the site of injection and trismatic patients.

The patient is asked to open mouth maximally. The mesiolingual cusp of the maxillary 2nd molar is the reference point for the height of the injection: The needle is then moved distally and is held parallel to an imaginary line drawn from the intertragic notch to the corner of the mouth

Vazirani-Akinosi Closed Mouth Mandibular Block The Vazirani-Akinosi closed mouth mandibular block is a useful

technique for patients with limited opening due trismus or ankylosis of the temporomandibular joint

Other advantages to this technique are the minimal risk of trauma to the inferior alveolar nerve, artery, vein, and pterygoid muscle, low complication rate and minimal discomfort upon injection

Contraindications to this technique are acute inflammation and infection in the pterygomandibular space, deformity or tumor in the maxillary tuberosity region.