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Mandibular teeth anesthetic block techniques
1. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
1. Main
Trunk
2. Nervous
Spimosum
3. Nerve
to
medial
pterygoid
4. Anterior
Division
1. N.
to
Temporalis
msc.
2. N.
to
Masse?er
msc.
3. N.
to
Lateral
Pterygoid
msc.
4. Long
Buccal
N.
5. Posterior
Division
1. Auriculo-‐temporal
N.
2. Lingual
Nerve
3. Inferior
Alveolar
N.
2. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Mandibular
anethesia
InfiltraJon
anesthesia
Anterior
labial
infl
anesth
Anterior
lingual
inf
anesth
Long
buccal
inf
anesth
Nerve
block
anesthesia
IA
and
L
NB
Mental
NB
Long
Buccal
NB
3. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Chair
posiJon
• DenJst
posiJon
• Syringe
• Needle
• Areas/Nerves
to
be
anestheJzed
-‐
Landmarks
• Point
of
inserJon
• DirecJon
of
injecJon
• Checking
the
anesthesia
8. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Aim
– To
deposit
the
anestheJc
soluJon
in
close
vicinity
to
the
Inferior
alveolar
nerve
just
before
its
entry
to
the
mandibular
foramen
– To
deposit
the
anestheJc
soluJon
in
close
vicinity
to
the
lingual
nerve
as
it
pass
anterior
and
medial
to
the
IAN
10. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Chair
posi*on
• Den*st
posi*on
• Syringe
:
AspiraJng
syringe
• Needle
• Nerves
to
be
anestheJzed
• Areas
to
be
anestheJzed
• landmarks
• Point
of
inserJon
• DirecJon
of
injecJon
• Checking
the
anesthesia
11. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Pa*ent
posi*on
• Head
,
neck
and
trunk
on
the
same
straight
line
• The
back
of
the
chair
is
Jlted
so
that
it
make
a
45
degree
angle
with
the
floor
• So
that
when
the
paJent
open
his
mouth
the
occlusal
plane
of
the
mandibular
teeth
becomes
parallel
to
the
floor
• The
occlusal
plan
of
mandibular
teeth
near
to
the
operator’s
elbow
Den*st
posi*on
• Right
side:
– From
infront
and
to
the
right
• LeY
side:
– From
infront
and
to
the
right
using
• Cross
hand
technique
• Using
leY
hand
– From
right
rear
posiJon
using
• From
behind
technique
12. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Chair
posiJon
• DenJst
posiJon
• Syringe
:
Aspira*ng
syringe
• Needle
• Nerves
to
be
anestheJzed
• Areas
to
be
anestheJzed
• landmarks
• Point
of
inserJon
• DirecJon
of
injecJon
• Checking
the
anesthesia
13. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Chair
posiJon
• DenJst
posiJon
• Syringe
:
AspiraJng
syringe
• Needle
:
Long
Needle
• Nerves
to
be
anestheJzed
• Areas
to
be
anestheJzed
• landmarks
• Point
of
inserJon
• DirecJon
of
injecJon
• Checking
the
anesthesia
14. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland
DVD
of
Head
and
Neck
Anatomy
15. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland
DVD
of
Head
and
Neck
Anatomy
16. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland
DVD
of
Head
and
Neck
Anatomy
Mand
17. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland
DVD
of
Head
and
Neck
Anatomy
MP
Msc
18. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland
DVD
of
Head
and
Neck
Anatomy
B
Msc
19. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland
DVD
of
Head
and
Neck
Anatomy
IAN
20. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland
DVD
of
Head
and
Neck
Anatomy
IAN
LN
22. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland
DVD
of
Head
and
Neck
Anatomy
23. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Chair
posiJon
• DenJst
posiJon
• Syringe
• Needle
• Nerves
to
be
anesthe*zed
– Incisive
Nerve
– Mental
nerve
– Inferior
alveolar
nerve
– Lingual
nerve
• Areas
to
be
anestheJzed
• landmarks
• Point
of
inserJon
• DirecJon
of
injecJon
• Checking
the
anesthesia
24. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Chair
posiJon
• DenJst
posiJon
• Syringe
• Needle
• Nerves
to
be
anestheJzed
• Areas
to
be
anesthe*zed
– All
the
pulp
and
invesJng
structures
of
lower
posterior
teeth
in
the
side
of
anesthesia
– Buccal
mucoperiosteum
of
the
anterior
teeth
and
premolars
– The
lingual
mucoperiosteum
of
the
same
side
– Floor
of
the
mouth
of
the
same
side
– Half
the
tongue
of
the
same
side
• landmarks
• Point
of
inserJon
• DirecJon
of
injecJon
• Checking
the
anesthesia
25. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Chair
posiJon
• DenJst
posiJon
• Syringe
• Needle
• Nerves
to
be
anestheJzed
• Areas
to
be
anestheJzed
• landmarks
• Point
of
inserJon
• DirecJon
of
injecJon
• Checking
the
anesthesia
26. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Landmarks:
– SoY
Jssue
landmarks:
• Muccobuccal
fold
• Buccal
pad
of
fat
• Retromolar
area
–
triangle
• Pterygomandibular
raphe
• Landmarks:
– Bony
landmarks:
• External
oblique
ridge
• Internal
oblique
ridge
• Anterior
border
of
the
ramus
• Coronid
process
• Coronoid
notch
28. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Chair
posiJon
• DenJst
posiJon
• Syringe
• Needle
• Nerves
to
be
anestheJzed
• Areas
to
be
anestheJzed
• landmarks
• Point
of
inser*on
• Direc*on
of
injec*on
• Checking
the
anesthesia
29. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Right
handed
operator
• The
operator
is
posiJoned
from
infront
and
to
the
right
42. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Wide
angle
of
flare
Direct
more
posterior
43. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Chair
posiJon
• DenJst
posiJon
• Syringe
• Needle
• Nerves
to
be
anestheJzed
• Areas
to
be
anestheJzed
• landmarks
• Point
of
inserJon
• DirecJon
of
injecJon
• Checking
the
anesthesia
– SubjecJve
findings
• Numbness
of
the
lower
lip
– ObjecJve
findings
• Probing
does
not
lead
to
pain
44. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Right
handed
operator
The
operator
is
posiJoned
on
the
right
front
of
the
paJent
– From
infront
and
to
the
right
• Cross
hand
technique
• LeY
hand
technique
– Right
rear
posiJon
• From
behind
technique
48. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Too
high
injec*on
• Too
low
injec*on
• Too
deep
injec*on
• Too
medial
injec*on
– A n e s t h e s i a
o f
t h e
auriclotemporal
nerve
:
Numbness
of
the
ear
– InjecJon
into
lateral
pterygoid
muscle
:
Soreness
and
trismus
49. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Too
high
injec*on
• Too
low
injec*on
• Too
deep
injec*on
• Too
medial
injec*on
• Failure
of
anesthesia
50. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Too
high
injec*on
• Too
low
injec*on
• Too
deep
injec*on
• Too
medial
injec*on
– Deposited
in
paroJd
gland
– Temporary
facial
nerve
paralysis
– ParoJJs
– D e p o s i t e d
i n t o
t h e
posterior
facial
vein
:
– Toxicity
– Deposited
into
medial
pterygoid
muscle
– Pain
– Trismus
51. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Too
high
injec*on
• Too
low
injec*on
• Too
deep
injec*on
• Too
medial
injec*on
– D e p o s i t e d
i n t o
t h e
constrictor
muscle
of
pharynx
:
disphagya
52. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Too
high
injecJon
– Anesthesia
of
the
auriclotemporal
nerve
:
Numbness
of
the
ear
– InjecJon
into
lateral
pterygoid
muscle
:
Soreness
and
trismus
• Too
low
injecJon:
– Failure
of
anesthesia
• Too
deep
injecJon:
– Deposited
in
paroJd
gland
• Temporary
facial
nerve
paralysis
• ParoJJs
– Deposited
into
the
posterior
facial
vein
:
• Toxicity
– Deposited
into
medial
pterygoid
muscle
• Pain
• Trismus
• Too
medial
injecJon
– Deposited
into
the
constrictor
muscle
of
pharynx
:
disphagya
54. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• This
technique
was
introduced
in
1973
by
the
Australian
operator
Dr.
George
Gow-‐gates
• It
provides
sensory
anesthesia
to
all
branches
of
the
Posterior
Division
and
Buccal
nerve
58. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• This
technique
was
reported
in
1977
by
Dr.
Joseph
Akinosi
• The
main
advantage
is
that
it
could
be
administrated
to
paJents
with
very
limited
mouth
opening
61. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• 0.2
ml
of
anestheJc
soluJon
is
deposited
at
the
apex
of
the
retromolar
triangle
between
the
external
and
internal
oblique
ridges
• Point
of
inserJon
– apex
of
the
retromolar
triangle
between
the
external
and
internal
oblique
ridges
• DirecJon
of
injecJon
– Parallel
to
the
occlusal
plane
from
the
same
side
62. Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
• Technique
– The
same
technique
as
the
inferior
alveolar
nerve
is
followed
except
that
the
point
of
inserJon
is
just
anterior
to
the
index
finger
or
the
area
palpated
with
the
syringe
oriented
over
the
teeth
of
the
same
side
to
be
injected
and
parallel
to
the
occlusal
plane.