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
1 2 3
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
12
3 4
1
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
12
3 4
1
Technique