بســم اللَـــه الرحمــن الرحيـــم. prof.dr.ragab shaaban

ــه الَلـ� بســمالرحيـــم الرحمــن

Prof.Dr.Ragab Shaaban

Local Analgesia In Dentistry

Maxillary nerve block

Intraoral approach

maxillary nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of anesthesia

a- subjective b- objective

The entire maxillary nerve and all its sub-divisions peripheral to site of injection.

maxillary nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of anesthesia

a- subjective b- objective

According to the technique used:

A- high tuberosity tech.

B- Greater palatine canal tech.

maxillary nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of anesthesia

a- subjective b- objective

* When anesthesia

for the entire max. nerve is required for extensive surgery.

* Presence of infection.* For diagnostic or

theraputic purposes

Maxillary nerve blockhigh tub. Tech. Greater palatine canal tech.

Extraoral maxillary block technques

A- infraorbital nerve block

B- maxillary nerve block

Infraorbital nerve block

Extraoral technique

Infraorbital nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

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4

Infraorbital nerve block

Maxillary nerve block

Extraoral technique

Maxillary nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of anesthesia

a- subjective b- objective

For extensive surgery. For all divisions with minimum amount of LA. When it is difficult to anesthetize a terminal branch. Diagnostic & theraputic reasons.

Landmarks

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Technique

Local analgesia

Mandibular techniques

Techniques of regional analgesia for the mandibular nerve & its subdivisions

A- intraoral techniques

Nerve supply of the mandible

• Inferior alveolar nerve block

Inferior alveolar nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. . Indications Technique. Symptoms of

anesthesia

a- subjective b- objective

Inferior alveolar nerve blockIndirect technique Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Mucobuccal fold Anterior ramus of the

mandible External oplique ridge Retromolar triangle Internal oplique ridge Pterygomandibular

ligament Buccal suking pad Pterygomandibular

space

Inferior alveolar nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

*Analgesia for operative dentistry on all mand. Teeth.

*Surgery on mand. teeth & supporting structures anterior to the frist molar + lingual NB

*Surgery on mand. teeth & supporting strucures posterior to the second bicuspid +lingual NB+ buccal NB.

*Diagnostic & therputic purpose

Inferior alveolar nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Techniques. Symptoms of

anesthesia

a- subjective b- objective

Indirect technique. Direct technique. Gaw-Gates technique. Closed mouth technique. Extraoral technique.

Inferior alveolar nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Inferior alveolar nerve block

Inferior alveolar nerve block

Inferior alveolar nerve block

Inferior alveolar nerve block

Technique of injection

III. PROPER INJECTION PROCEDURES

B- REGIONAL OR BLOCK ANESTHESIA:a- Block anesthesia in the mandible:Errors in needle insertion:1. Too high insertion: Numbness of the ear as a result of

anesthesia of the auriculotemporal nerve.

Post-injection pain & Trismus due to hitting of the insertion of the temporalis or lateral pterygoid.

Post-injection pain & Trismus due to hitting of the insertion of the temporalis or

lateral pterygoid.

B- REGIONAL OR BLOCK ANESTHESIA:

a- Block anesthesia in the mandible:Errors in needle insertion:1. Too high insertion: Temporary facial paralysis due to

dissemination of the solution to the branches of the facial nerve.

Double vision or temporary blindness due to dissemination of the solution through inferior orbital fissure to the lateral rectus muscle or to the optic nerve.

Haematoma in the deep temporal spaces by hitting the pterygoid venous plexus.

Errors in needle insertion

1. Too low insertion:

Trismus due to trauma of the medial pterygoid.

Injection into the posterior

facial vein.

B- REGIONAL OR BLOCK ANESTHESIA

a- Block anesthesia in the mandible:

Errors in needle insertion:

1. Too medial insertion: Nausea & vomiting from

dissemination of solution to the pharynx.

Dysphagea due to haematoma of the lateral pharyngeal space.

Inferior alveolar nerve blockdirect technique

Inferior alveolar nerve block Gaw-Gates techniqe It is considered a high mandibular block.Landmarks are :

- angle of the mouth.

- intertragic notch .

- neck of the condyle.

Inferior alveolar nerve blockGow-Gates technique

Inferior alveolar nerve blockGow-Gates technique

Closed mouth technique(Vazirani tech.)

Causes of failure of local analgesia Insuffecient knowledge of local anatomy

of the region.Faulty technique. Individual anatomical variations occuring

in different patients. Intravascular injection.Needle deflection. Inflammation.

Failure of mandibular anesthsia(Anatomical variations)

Causes of failure(Faulty technique)

Lingual nerve block

Lingual nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Lingual nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

The same land-marks of the inferior alveolar nerve block.

Lingual nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

For surgery on the anterior 2/3 of the tongue ,floor of the mouth and mucous membrane on the lingual side of the mandibule.

Lingual nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Lingual nerve block

Lingual nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Long buccal nerve block

Long buccal nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Long buccal nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

External oplique ridge.

* Retromolar triangle.

Long buccal nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

External oplique ridge.

* Retromolar triangle.

long buccal nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

* Surgery on the buccal mucosa.

* To supplement the inferior alveolar nerve block.

Long buccal nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Mental nerve block

Mental nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Mental nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

* Lower lip.

* mucous membrane in the mucobuccal fold anterior to the mental foramen.

Mental nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

For surgery on the lower lip or mucous membrane in the mucobuccal fold anterior to the mental foramen.

Mental nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Incisive nerve block

Incisive nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Incisive nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

The same like mental nerve block.

Incisive nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

For anesthesia of the mandibule and labial mandibular structures anterior to the mental foramen and lower lip.

Incisive nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Extraoral mandibular block techniques

A- mental & incisive nerve blockB-inferior alveolar nerve block

C- Mandibular nerve block

Mental & incisive nerve block

Extraoral techniques

Mental & incisive nerve block

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia

a- subjective b- objective

Bicuspid teeth Lower edge of the body

of the mand Supraorbital notch Infraorbital notch Pupil of the eye

Technique

Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of

anesthesia a- subjective

b- objective

Patient looks forward An imaginary line drown

from supraorbital n.-pupil-infraorbital n., if continued downward will pass through the mental foramen

Midpoint is detected between gingival margine and lower border of the mand.

Ant.&downward insertion with gentle proping

Inferior alveolar nerve block

Extraoral technique

Kurt Thoma

Technique

This technique is only used when there is severe limitation of opening of the jaws as with TMJ ankylosis.

Complete asepsis should be considered.

Technique Anteroinferior border of the

masseter is located & marketed

A line connecting it with the tragus of the ear is drown and bisected

This midpoint marks the mand. foramen externally

A line is drown down to the inferior border of the mand and parallel to the posterior border of the mand.

Technique

Needle is inserted should be parallel to this line and of equal length

Mandibular nerve block

Extraoral technique

Landmarks

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3 4

1

Technique