Anesthesia Injections – Flashcards
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What operator preparation do you need before giving LA
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-Review medical history -get CC -clinical examination -know the type of procedure -decide the location and type of injection
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What are the major injection techniques?
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Supraperiosteal (infiltration), Blocks
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What are the supplemental injection techniques?
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-Direct Pulpal -Periodontal ligament -Intraosseous -Intraseptal
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How do you prepare the tissue for injection?
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Dry with gauze, apply topical anesthetic, pull tissue taut (this decreases the depth of the tissue and allows for a more comfortable injection)
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What are the branches of the trigeminal?
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Opthalmic, Maxillary (sensory), Mandibular (sensory and motor)
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Branches of the Mandibular nerve
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Lingual nerve, Inferior alveolar nerve, mental nerve
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Inferior alveolar nerve block Landmarks
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Coronoid notch, posterior border of ramus, occlusal plane, pterygomandibular raphe
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Inferior Alveolar Nerve Block Technique
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Position pt so that the occlusal plane is parallel to the floor, place thumb in the coronoid notch so the inferior border of your thumb is parallel to the occlusal plane, other fingers are placed extra-orally on the posterior border of the the ramus of the mandible. Direct the syringe from the PM of the opposite side so that you approach the bone at a right angle. Bisect you thumb, then go a bit higher (follow the path of the MB cusp of the max first molar). Once you hit bone, swing the syringe toward the mand lat incisors and insert to a depth of 2/3 or 3/4 of the needle. Aspirate, then inject slowly
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What is the most common location for the mandibular foramen?
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6-10mm above the occlusal plane (could be anywhere from 1-19mm though)
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What are the reasons for failure for the Inferior alveolar nerve block?
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Anatomic variations, too low, too medial, too posterior (give them bells palsy), too high into sigmoid notch
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What nerves are usually included in an IANB?
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Inferior alveolar, incisive, mental, and sometimes the lingual
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What areas do the IANB anesthetize?
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Mandibular teeth to the midline, body of the mandible and inferior portion of the ramus, buccal mucoperiosteum, mucous membrane anterior the the mand 1st molar, anterior 2/3 of the tongue and floor of the oral cavity,
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What are the other names for an IANB?
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Mandibular Block
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Long Buccal Nerve Block: area anesthetized
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gingiva, buccal mucosa to the corner of the lip (NOT the teeth)
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What are the other names for the Long Buccal Nerve Block?
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Buccal Nerve Block, buccinator nerve block
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Long Buccal Nerve Block technique
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Pull out cheek to stretch buccal mucosa, bevel of needle toward bone, Insert parallel with the occlusal plane but buccal to it, distal and buccal to the last molar
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Lingual Nerve Block
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usually anesthetized when doing an IANB, but can also be given to the lingual and at the apex of the last molar
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Mental/Incisive Nerve Block
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This is the terminal branch of the inferior alveolar nerve and provides innervation to the teeth anterior to the mental foramen (PM-PM). This nerve is always anesthetized with an IANB is successful
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Mental/Incisive Nerve block injection site
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mental foramen is normally b/t the 1st and 2nd PM roots
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Mental/Incisive Nerve block technique
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Retract the lip and stretch the tissue, insert needle at PM and direct the needle towards to mental foramen. Penetrate 5-6mm, aspirate, then inject
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Infiltration (supraperiosteal) Injection
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This is a local infiltration. Aim for the apex of the target tooth (make sure you are parallel to the long access of the tooth). Most common Max injection but not good for large areas
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Supraperiosteal Injection: area anesthetized
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target tooth + 1/2 of the tooth on either side
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Middle Superior Alveolar (MSA) Nerve Block technique
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Aim for periapical region mesial to the maxillary second molar
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Middle Superior Alveolar Nerve Block: area anesthetized
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two PM and the mesial root of the 1st molar
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Posterior Superior Alveolar (PSA) Injection technique
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target area for the injection is the posterior aspect of the tuberosity. Inject at the height of the mucobuccal fold above the max 2nd molar. Advance the needle at a 45 degree angle to the occlusal plane and move needle inward, upward, and backward
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Posterior Superior Alveolar Injection: area anesthetized
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1st-3rd molars (except MB root of 1st molar 28% of the time). Usually should do a PSA and ASA to make sure that you got everything.
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PSA possible complications
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hematoma that would be visible on the face for 10-14 days
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Anterior Superior Alveolar (ASA) Nerve block is also known as...?
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Infraorbital nerve block
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Most common use for ASA
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Use instead of doing multiple supraperiosteal injections
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ASA: Area anesthesized
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Max cent incisor to the max 2nd PM
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ASA technique
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Palpate to find the infraorbital notch (usually lines up with the commisure of the lip and the pupil). With finger over the foramen, pull the lip taught and insert in the muccobucca fold over the max 1st PM (about 16mm)
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Nasopalatine nerve Block is also known as...
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Incisive nerve block, sphenopalatine nerve block
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Nasopalatine Nerve Block: area anesthetized
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palatal anesthesia from distal of canine to distal of canine
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Nasopalatine Nerve block technique
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Insert needle on palatal mucosa just lateral to the incisive papilla. Apply pressure to the area with the swab while giving the injection to decrease pain
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Greater Palatine Nerve Block technique
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Location of the foramen is between the 2nd and 3rd molars. Want to find the foramen with a swab and apply pressure just lateral to the injection site.
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Gow-Gates Mandibular Nerve Block (GGMNB)
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This is a true mandibular nerve block because it provides sensory anesthesia is ALL of V3 (inferior alveolar, lingual, mylohyoid, mental, incisive, auriculotemporal, and buccal).
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GGMNB: area anesthetized
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...pretty much everything for 1/2 of the mandible
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GGMNB technique
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Insert just below the ML cusp of the max 2nd molar just distal to the molar. Direct the syringe toward the tragus (be parallel with the line connecting the corner of the mouth with the tragus). Want the pt to open wide and extend the neck so the condyle is more frontal
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Vazirani-Akinowsi Block is useful when...
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This is also known as the closed mouth technique and is good for if the pt has trismus.
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Vazirani-Akinowsi Block technique
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Barrel of the syringe is held parallel to the max occlusal plane with the needle inserting at the level of the mucogingival jctn of the 2nd or 3rd max molar. The needle is advance ~25mm, aspirate, then inject
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Periodontal Ligament Injection
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Inject into the 4 corners of the PDL. Good for if the pt is numb everywhere but one tooth, good for kids, extractions. Prevents the lip, tongue, and other tissues from being anesthetized. Completely numbs the tooth, pulp, and surrounding tissue.
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Interseptal Injection
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Similar to the PDL injection. Inject into the center of the interdental papilla. Numbs bone, soft tissue, and root structure in the area of the injection
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Direct Pulpal/Intrapulpal Injection
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Deposition of anesthetic directly into the pulp chamber. This is used to numb the pulp for pulpal extraction and instrumentation when everything else has failed.
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Intraosseous Injection
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Incision into soft tissue, drill hole into bone with round bur, and inject local anesthetic into the hole. Can use an INTRAFLOW IO system for this
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What are the two approaches to the Maxillary Nerve Block?
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1. High Tuberosity Approach 2. Greater Palatine Canal Approach (more common)
