INFERIOR ALVEOLARNERVE BLOCK

PRESENTED BY:Malik Hina

BDS IIIrd yr.

Inferior alveolar nerve

Inferior alveolar nerve block is a nerve block technique which induces anesthesia in the areas of mouth & face innervated by the inferior alveolar nerve.The inferior alveolar nerve is a branch of the mandibular nerve, the third division of the trigeminal nerve.This procedure attempts to anesthetize this nerve prior to its entry in the mandibular foramen

INTRODUCTION

NERVES ANESTHETIZED

Incisive nerve

AREAS ANESTHETIZED

5) Lingual soft tissues & periosteum (lingual nerve)

1) Mandibular teeth to the midline

2) Body of the mandible, inferior portion of the ramus

3) Buccal mucoperiosteum, mucous membrane anterior to the mandibular first molar (mental nerve)

4) Anterior two thirds of the tongue & the floor of the oral cavity (lingual nerve)

ANATOMICAL LANDMARKS1) Pterygomandibular fold2) Anterior border of ramus of mandible

3) External oblique ridge

4) Retromolar Triangle

5) Internal Oblique ridge

6) Coronoid Notch

7) Pterygomandibular raphae

8) Pterygomandubular space9) Buccal sucking pad

Technique

Two techniques:

Direct techniq

ue

•Also called…….•Inferior alveolar nerve is anesthetized first

Indirect techniq

ue

•Also called Fissure 1-2-3 technique•Inferior alveolar nerve is anesthetized at the 3rd position.

1)Inferior alveolar2)Lingual 3)Long buccal

1) Long buccal

2) Lingual 3) Inferior

alveolar

DIRECT TECHNIQUE1ST POSITION: IAN is anaesthetized from the opposite side

2nd POSITION: Lingual nerve is anaesthetized from the same side3rd POSITION: Long buccal nerve is anaesthetized from the same side

INDIRECT TECHNIQUE1ST POSITION: Long Buccal nv. is anaesthetized form the same side2nd POSITION: Lingual nerve is anaesthetized from the same side3rd POSITION: IAN is anaesthetized from the opposite side

POSITION OF THE PATIENT

Position the patient supine (recommended) or semi supine.

The mouth should be opened wide to permit greater visibility of and access to the injection site.

When semi supine the mandible of the patient should be parallel to the floor.

For right IANB, a right handed administrator should sit at the 8 o’clock position facing the patient.

For left IANB, a right handed administrator should sit at 10 o’clock position facing the same direction as the patient

POSITION OF THE ADMINISTRATOR:

1) The area of greatest depth i.e., the coronoid notch is identified

2) Palpating finger is moved across the retromolar traingle & onto the internal oblique ridge

3) The thumb is moved towards the buccal side taking with it the buccal sucking pad

TECHNIQUE

4)The operator may place the index finger extraorally behind the ramus of mandible. In this manner the anteroposterior width of the ramus may be assessed.

5)Ask the patient to keep the mouth wide open.A syringe with 25 gauge needle is inserted parallel to the occlusal plane of the mandibular teeth from the opposite side of the mouth at a lavel bisecting the finger, peneterating the tissues of the pterygotemporal depression & entering the pterygomandibular space

6)The needle is penetrated into the tissues until gently contacting bone on the internal surface of ramus of mandible.7)The needle is the withdrawn about 1mm, after negative aspiration, 1 to 1.8ml solution is deposited slowly (1 ½ to 2mins)

8)½ of the inserted depth is withdrawn , the remainder of the solution is injected to anesthetize the lingual nerve.

TECHNIQUE FOR LEFT INFERIOR ALVEOLAR NERVE BLOCK:PATIENT POSITION: SAMEOPERATOR POSITION: TOWARDS RIGHT & SLIGHTLY TOWARDS THE BACK OF THE PATIENT.ARM IS PLACED AROUND PATIENTS HEAD.

COMPLICATIONS1) TRANSIENT FACIAL PARALYSIS:Produced by deposition of local anesthetic into the body of the parotid gland.SIGNS AND SYMPTOMS: INABILITY TO CLOSE THE LOWER EYELID & DROPPING OF THE LIP ON THE AFFECTED SIDE

3)HEMATOMA (RARE):A) Swelling of tissues on

the medial side of the mandibular ramus after deposition of the anesthetic.

B) MANAGEMENT: Pressure & cold (e.g., ice) to the area for a minimum of 3 to 5mins.

4) TRISMUS:Muscle soreness or limited movements1) Slight soreness is

quite common after IANB

2) More severe soreness rare

Thank you