Inferior Alveolar Nerve Block The inferior alveolar nerve block technique is the one with the highest percentage of failure (15%-20%), so we have to train well well to o it!
Causes of failure: 1. "nato#ical variation in the height of the #anibular fora#en on the ra#us! 2. $rong anato#ical eter#ination! 3. n&ection into area of infection! 4. 'reater epth of soft tissue penetration require! 5. ntravascular in&ection!
Anesthetized Anesthetiz ed area Nerve anesthetized *o+ of the #anible inferior portion of nferior alveolar nerve its the ra#us subivisions (ingual nerve - anibular teeth nerve to buccinator) - ucous #e#brane unerl+ing tissues (anterior to the #olars)
Symptoms of anesthesia: (How to test anesthesia??): 1. n the ma!illa , we test the anesthesia onl+ b+ instru#ent (o"#e$ti%e).$e use the probe in certain point pierce the #ucosa till it touches the bone! f anesthesia is given correctl+, so no pain will be felt ecept for pressure!! 2. n the man&i"le, the+ are 2 wa+s (sub&ective ob&ective) a) Su" Su"#e$t #e$ti%e i%e sym symptom ptoms: s: tingling nu#bness of the lower lip, corner of the #outh tip of the tongue ue to lingual nerve block! .!*/ .u#bness alwa+s alwa+s ens the #iline! ") '"# '"#e$t e$ti%e i%e sym symptom ptoms: s: nstru#entation reveals absence of pain sensation!
' *'+: Tell the patient not to close herhis e+es cause e+es is the 1 part of the bo+ that etect pain, also earl+ signs of toicit+ can be etecte through e+es! Therefore, opening e+es is ver+ i#portant for co##unication with the patient without wors for etecting earl+ responses! st
Contrain&i$ation of inferior al%eolar ner%e "lo$,: 1. nfection or acute infla##ation in area of in&ection! 2. er+ +oung chilren, ph+sicall+ or #entall+ hanicappe patients!
Advantages:
3ne in&ection provies wie area of anesthesia
Disadvantages: 1. 2. 3. 4. 5.
4ailure (15%-20%) $ie area of anesthesia ositive aspiration rate 10%- 15% ntraoral lan#arks not consistentl+ reliable ingual lower lip anesthesia isco#forting to #a+ patients possibl+ angerous in certain iniviuals!
Technique: 6se long neele, aspiration is ver+ i#portant because inferior alveolar arter+ is ver+ close!! 437 836/ .ever ever reirect the neele insie the tissue, otherwise fracture #a+ happen! 1. The ine finger the left han (for right hane) is place in the
#ucobuccal fol opposite to the bicuspi teeth or area! 2. ove the finger posteriorl+ until reaching the eternal oblique rige,
then the anterior borer of the ra#us to the coronoi process! .: tell the patient to open his #outh as wie as he can, so +ou can insert the neele correctl+ to get the correct lan#ark!! 3. 9eep the finger in contact with the anterior borer of the coronoi
process #ove the finger own until the greater epth on the anterior borer of the ra#us (coronoi notch) is reache!
4. The finger is kept in contact with coronoi notch, an then rotates the
finger so that the finger nail is turne towars the sagittal plane! 5. "t this point, slie the finger tip linguall+ felt the internal oblique
rige, this area is calle the retromolar trian/le! 0. The point of the neele insertion lies about .5 $m in front of the
#ile of the tip of the left ine finger nail, the neele is istal to ptr+gopalatine raphe! The anesthetic s+ringe loae with the carpule, #ounte with long neele (:2##) hel b+ the operator right han in a pen grasp parallel to the occlusal plane of the lower teeth irecte fro# the pre#olar area of the opposite sie
the neele is inserte
to the previous point! . f the neele is in the correct position, it shoul touch bone about
20 -:0## (2; of the neele is inserte), in&ect about 1.5 $$ of the anesthetic solution! . $ithraw the neele about .5 mm in&ect .5 $$ of the anesthetic
solution to anesthetith
?th or large flab is one in this area ( .1 $$ for long buccal nerve
infiltration)
ee&le pathway &urin/ insertion: -
ucosa, a thin plate of buccinator #uscle, loose @!T fat
-
f the neele is inserte far #ore posteriorl+
Tris#us #a+ occur!
-
f the neele is ver+ eep inserte or inserte fro# the sa#e site
paroti glan #a+ be hurt facial nerve in&ur+ #a+ occur (facial nerve pals+) but itAs #ore severe when inserte fro# the sa#e sie!
ppro!imatin/ stru$tures when the nee&le is in position the position of the nee&le shoul& "e: - Superior to the inferior alveolar vessels , inferior alveolar insertion of the #eial ptr+goi #uscle, #+loh+oi vessels nerves - nterior to eep part of the paroti glan - 6e&ial to the inner surface of the ra#us of the #anible - 7ateral to the lingual nerve #eial ptr+goi #uscle spheno#anibular liga#ents!
8rrors in the nee&le insertion in $ase of inferior al%eolar ner%e "lo$,: 1. f the neele puncture is too high too far #eiall+ fro# the internal oblique rige the solution #a+ be in&ecte into the lateral ptr+goi #uscle this result in tris#us 2. The solution #a+ be in&ecte into superior constrictor #uscle of the phar+n causing profoun nu#bness of the throat patient will co#plain of feeling so#ething in the throat! 3. The neele #a+ penetrate on the ptr+goi venous pleus which cover the #eial ptr+goi #uscle , an this #a+ result into he#ato#a in the ptr+go#anibular space (so for this reason we nerve give it to he#ophilic patient)! 4. uncture point along the internal oblique rige but too high the neele is avance to eepl+ 5. .u#bness of the ear will result fro# anesthesia of the articulote#poral nerve or the solution #a+ be eposite in the insertion of lateral ptr+goi #uscle with subsequent soreness tris#us no effective anesthesia to the teeth! 0. The neele #a+ be passe through the sig#oi notch , the solution is eposite in the #asseter resulting in #uscle ee#a , tris#us no effective anesthesia . The neele puncture #a+ be high , but not avance too eepl+, the solution #a+ be eposite into te#poralus #uscle the patient will co#plain of tris#us, soreness failure of anesthesia
. f the neele passe the insertion of te#poralus #uscle, the patient #a+ have weak anesthesia 9. f the neele puncture is along the internal oblique rige but too low , this is the #ost co##on error , it results in failure of anesthesia a) The solution #a+ eposite to the insertion of #eial ptr+goi the patient will co#plain of pain tris#us ") The solution #a+ eposite into the paroti glan with the resultant parotitis $) The solution #a+ be eposite into the paroti glan near the facial nerve with resultant relaation of all facial #uscles &) The solution #a+ eposit into the paroti facial vein with resultant toicit+, pallor, weakness, nausea, convulsion, are quickl+ #anifeste patient skin beco#e pall his bloo pressure pulse are lowere!
