Inferior Alveolar Nerve Block

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Inferior Alveolar Nerve Block

  1. 1. Techniques of Mandibular Anesthesia Prepared by Dr shabeel pn
  2. 2. Mandibular Anesthesia Lower success rate than Maxillary anesthesia - approx. 80-85 % Related to bone density Less access to nerve trunks  
  3. 3. Mandibular Nerve Blocks <ul><li>Inferior alveolar </li></ul><ul><li>Mental - Incisive </li></ul><ul><li>Buccal </li></ul><ul><li>Lingual </li></ul><ul><li>Gow-Gates </li></ul><ul><li>Akinosi </li></ul>
  4. 4. Mandibular Anesthesia <ul><li>Most commonly performed technique </li></ul><ul><li>Has highest failure rate (15-20%) </li></ul><ul><li>Success depends on depositing solution within 1 mm of nerve trunk </li></ul>
  5. 5. Inferior Alveolar Nerve Block <ul><li>Not a complete mandibular nerve block. </li></ul><ul><li>Requires supplemental buccal nerve block </li></ul><ul><li>May require infiltration of incisors or mesial root of first molar </li></ul>
  6. 6. Inferior Alveolar Nerve Block <ul><li>Nerves anesthetized </li></ul><ul><li>Inferior Alveolar </li></ul><ul><li>Mental </li></ul><ul><li>Incisive </li></ul><ul><li>Lingual </li></ul>
  7. 7. Inferior Alveolar Nerve Block <ul><li>Areas Anesthetized </li></ul><ul><li>Mandibular teeth to midline </li></ul><ul><li>Body of mandible, inferior ramus </li></ul><ul><li>Buccal mucosa anterior to mental foramen </li></ul><ul><li>Anterior 2/3 tongue & floor of mouth </li></ul><ul><li>Lingual soft tissue and periosteum </li></ul>
  8. 8. Inferior Alveolar Nerve Block <ul><li>Indications </li></ul><ul><li>Multiple mandibular teeth </li></ul><ul><li>Buccal anterior soft tissue </li></ul><ul><li>Lingual anesthesia </li></ul>
  9. 9. Inferior Alveolar Nerve Block <ul><li>Contraindications </li></ul><ul><li>Infection/inflammation at injection site </li></ul><ul><li>Patients at risk for self injury (eg. children) </li></ul>
  10. 10. Inferior Alveolar Nerve Block <ul><li>10%-15% positive aspiration </li></ul>
  11. 11. Inferior Alveolar Nerve Block <ul><li>Alternatives </li></ul><ul><li>Mental nerve block </li></ul><ul><li>Incisive nerve block </li></ul><ul><li>Anterior infiltration </li></ul>
  12. 12. Inferior Alveolar Nerve Block <ul><li>Alternatives (cont.) </li></ul><ul><li>Periodontal ligament injection (PDL) </li></ul><ul><li>Gow-Gates </li></ul><ul><li>Akinosi </li></ul><ul><li>Intraseptal </li></ul>
  13. 13. Inferior Alveolar Nerve Block <ul><li>Technique </li></ul><ul><li>Apply topical </li></ul><ul><li>Area of insertion : </li></ul><ul><li>medial ramus, mid-coronoid notch, </li></ul><ul><li>level with occlusal plane (1 cm above), </li></ul><ul><li>3/4 posterior from coronoid notch to pterygomandibular raphe </li></ul><ul><li>advance to bone (20-25 mm) </li></ul>
  14. 14. Inferior Alveolar Nerve Block <ul><li>Target Area </li></ul><ul><li>Inferior alveolar nerve, near mandibular foramen </li></ul><ul><li>Landmarks </li></ul><ul><li>Coronoid notch </li></ul><ul><li>Pterygomandibular raphe </li></ul><ul><li>Occlusal plane of mandibular posteriors </li></ul>
  15. 15. Inferior Alveolar Nerve Block <ul><li>Precautions </li></ul><ul><li>Do not inject if bone not contacted </li></ul><ul><li>Avoid forceful bone contact </li></ul>
  16. 16. Inferior Alveolar Nerve Block <ul><li>Failure of Anesthesia </li></ul><ul><li>Injection too low </li></ul><ul><li>Injection too anterior </li></ul><ul><li>Accessory innervation </li></ul><ul><li>-Mylohyoid nerve </li></ul><ul><li>-contralateral Incisive nerve innervation </li></ul>
  17. 17. Inferior Alveolar Nerve Block <ul><li>Complications </li></ul><ul><li>Hematoma </li></ul><ul><li>Trismus </li></ul><ul><li>Facial paralysis </li></ul>

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