This document describes various techniques for mandibular nerve blocks, including the inferior alveolar nerve block, buccal nerve block, Gow-Gates technique, Vazirani-Akinosi closed mouth mandibular block, mental nerve block, and incisive nerve block. It provides details on the target sites, techniques, and areas of anesthesia achieved for each type of mandibular nerve block.
Local aneasthesia techniques which are to be performed extraorally when the conventional intraoral approches for local anaesthesia cant be performed.
Very useful for dental Practioners
Local aneasthesia techniques which are to be performed extraorally when the conventional intraoral approches for local anaesthesia cant be performed.
Very useful for dental Practioners
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
Oral surgery
Mandibular nerve block.
Local anaesthesia.
Areas anaesthetised.
Technique
Placement of needle
advanatges and disadvantages of this technique
Complications
Failure of IANB
Anatomy
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
Border Moulding in Complete Denture Prosthesis ,This Seminar was presented By Dr. Alim Al Razi,DR. Halima Sadia, and Dr. Tahmina Akter at prosthodontics Department ,Dhaka Dental College and Hospital.We tried To cover Full theoretical and practical Information Regarding This Topic.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
Oral surgery
Mandibular nerve block.
Local anaesthesia.
Areas anaesthetised.
Technique
Placement of needle
advanatges and disadvantages of this technique
Complications
Failure of IANB
Anatomy
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
Border Moulding in Complete Denture Prosthesis ,This Seminar was presented By Dr. Alim Al Razi,DR. Halima Sadia, and Dr. Tahmina Akter at prosthodontics Department ,Dhaka Dental College and Hospital.We tried To cover Full theoretical and practical Information Regarding This Topic.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Mandibular Nerve Block - By Dr Saikat Saha Dr Saikat Saha
Mandibular nerve block techniques in short for Dental Surgeons. Mandibular nerve blocks are very important for all dental surgeons as it becomes a part and parcel of all dental and oral surgeons. This presentation will be useful for students of dentistry and doctors.
Local Anesthesia in childs , dentistry for adoleclsencehanimortezaeee
injection is the dental procedure that produces the greatest negative response in children.
Topical anesthetics are available in gel, liquid, ointment, and pressurized spray forms. However, the pleasant-tasting and quick-acting liquid, gel, or ointment preparations seem to be preferred by most dentists.
Ethyl aminobenzoate (benzocaine) liquid, ointment, or gel preparations are probably best suited for topical anesthesia in dentistry.
The mucosa at the site of the intended needle insertion is dried with gauze, and a small amount of the topical anesthetic agent is applied to the tissue with a cotton swab. Topical anesthesia usually produces an effect within 30 seconds, although keeping it in place between 2 and 3 minutes may provide the best results
The jet injection instrument is based on the principle that small quantities of liquids forced through very small openings under high pressure can penetrate the mucous membrane or skin without causing excessive tissue trauma.
Jet injection produces surface anesthesia instantly and is used instead of topical anesthetics by some dentists.
The method is quick and essentially painless; however the abruptness of the injection may produce momentary anxiety in the patient. This technique is also useful for obtaining gingival anesthesia before a rubber dam clamp is placed for isolation procedures
INFERIOR ALVEOLAR NERVE BLOCK (CONVENTIONAL MANDIBULAR BLOCK)
the mandibular foramen is situated at a level lower than the occlusal plane of the primary teeth of the pediatric patient. Therefore the injection must be made slightly lower and more posteriorly than for an adult patient.
An accepted technique is one in which the thumb is laid on the occlusal surface of the molar, with the tip of the thumb resting on the internal oblique ridge and the ball of the thumb resting in the retromolar fossa.
The barrel of the syringe should be directed on a plane between the two primary molars on the opposite side of the arch.
The depth of insertion averages about 15 mm but varies with the size of the mandible
Approximately 1 mL of the solution should be deposited around the inferior alveolar ne
Lingual nerve block
One can block the lingual nerve by bringing the syringe to the opposite side with the injection of a small quantity of the solution as the needle is withdrawn. If small amounts of anesthetic are injected during insertion and withdrawal of the needle for the inferior alveolar nerve block, the lingual nerve will invariably be anesthetized as well.
Long buccal nerve block
A small quantity of the solution may be deposited in the mucobuccal fold at a point distal and buccal to the last tooth
All facial mandibular gingival tissue on the side that has been injected will be anesthetized for operative procedures, with the possible exception of the tissue facial to the central and lateral incisors, which may receive innervation from ove
SUPRAPERIOSTEAL TECHNIQUE (LOCAL INFILTRATION) The injection sho
oral surgery - techniques of local anesthesia powerpoint Mustafatj1
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Presentation on Maxillary nerve block which helps for a quick refresh.
Applied aspects described well and slides contains images for easy understanding of the subject.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
How to Give Better Lectures: Some Tips for Doctors
mandibular nerve-block
1. Types and Techniques of
Mandibular nerve block
By
Dr. Said Ahmed Mohamed
B.D.S. , FDSRCS Edin.
Consultant Oral & Maxillofacial
Surgery
Saqr Hospital
2. Types of Mandibular Regional
Anesthesia
• Inferior Alveolar Nerve Block
Mandibular teeth on side of injection, buccal and lingual hard and soft tissue, lower lip
• Buccal Nerve Block
Buccal soft tissue of molar region
• Gow-Gates Mandibular Nerve Block
Mandibular teeth to midline, hard and soft tissue of buccal and lingual aspect,
anterior 2/3 of tongue, FOM, skin over zygoma, posterior aspect of cheek, and
temporal region on side of injection
• Vazirani-Akinosi Closed Mouth
Mandibular teeth to midline, hard and soft tissue of buccal aspect, anterior 2/3 of
tongue, FOM
• Mental Nerve Block
Buccal soft tissue anterior to mental foramen, lower lip, chin
• Incisive Nerve Block
Premolars, canine and incisors, lower lip, skin over the chin, buccal soft tissue anterior
to the mental foramen
3. Techniques of Mandibular Regional
Anesthesia
• Techniques used in clinical practice for the anesthesia of the hard
and soft tissues of the mandible include the supraperiosteal
technique, PDL injection, intrapulpal anesthesia, intraseptal
injection, inferior alveolar nerve block, long buccal nerve block,
Gow-Gates technique, Vazirani-Akinosi closed mouth mandibular
block, mental nerve block, and incisive nerve block.
• The supraperiosteal, PDL, intrapulpal, and intraseptal techniques
are executed in the same manner as described above for maxillary
anesthesia. When anesthetizing the mandible the patient should be
in the semisupine or reclined position. The right handed operator
should stand at the nine o’clock to ten o’clock position whereas the
left handed operator should stand at the three o’clock to four o’
clock position.
4. Inferior Alveolar Nerve Block
• The inferior alveolar nerve block is one of the most
commonly employed techniques in mandibular
regional anesthesia.
• It is extremely useful when multiple teeth in one
quadrant require treatment. While effective, this
technique carries a high failure rate even when strict
adherence to protocol is maintained.
• The target for this technique is the mandibular nerve
as it travels on the medial aspect of the ramus, prior to
its entry into the mandibular foramen. The lingual,
mental, and incisive nerves are also anesthetized.
• A 25 gauge long needle is preferred for this technique.
5. • Technique :
• The patient should be in the semisupine position. The right handed
operator should be in the eight o’clock position whereas the left
handed operator should be in the four o’clock position.
• With the mouth open maximally, identify the coronoid notch and
the pterygomandibular raphae.
• Three quarters of the anteroposterior distance between these two
landmarks, and approximately six to ten millimeters above the
occlusal plane is the injection site.
• Use a retraction instrument to retract the cheek and bring the
needle to the injection site from the contralateral premolar region.
• As the needle passes through the soft tissue, deposit one or two
drops of anesthetic solution.
6. • Advance the needle until bone is contacted. Once bone is
contacted, withdraw the needle one millimeter and redirect the
needle posteriorly by bringing the barrel of the syringe towards the
occlusal plane (Fig. 18, A and B).
• Advance the needle to three quarters of its depth, aspirate, and
inject three quarters of a cartridge of anesthetic solution slowly
over the course of one minute.
• As the needle is withdrawn, continue to deposit the remaining one
quarter of anesthetic solution so as to anesthetize the lingual nerve
(Fig. 18, C).
• Successful execution of this technique results in anesthesia of the
mandibular teeth on the ipsilateral side to the midline, associated
with buccal mucosa anterior to the mental foramen, lingual soft
tissue, lateral aspect of the tongue on the ipsilateral side, and lower
lip on the ipsilateral side.
7.
8.
9. Figure 18 A: Location of the inferior alveolar nerve. B: After contacting bone,
the needle is redirected posteriorly by bringing the barrel of the syringe
towards the occlusal plane. The needle is then advanced to three quarters of
its depth
10. Figure 18 C: Location of the lingual nerve which is anesthetized
during the administration of an inferior alveolar nerve block
11.
12. Buccal Nerve Block
• The buccal nerve block, otherwise known as the long
buccal or buccinator block, is a useful adjunct to the
inferior alveolar nerve block when manipulation of the
buccal soft tissue in the mandibular molar region is
indicated.
• The target for this technique is the buccal nerve as it
passes over the anterior aspect of the ramus.
• Contraindications to the procedure include acute
inflammation and infection over the site of injection.
• A 25 gauge long needle is preferred for this technique.
13. • Technique-
• The patient should be in the semisupine position. The right
handed operator should be in the eight o’clock position
whereas the left handed operator should be in the four
o’clock position.
• Identify the most distal molar tooth on the side to be
treated. The tissue just distal and buccal to the last molar
tooth is the target area for injection (Fig. 19, A and B).
• Use a retraction instrument to retract the cheek.
• The bevel of the needle should be toward bone and the
syringe should be held parallel to the occlusal plane on the
side of the injection.
•
14. • The needle is inserted into the soft tissue and a
few drops of anesthetic solution are
administered.
• The needle is advanced approximately one or
two millimeters until bone is contacted. Once
bone is contacted and aspiration is negative,
0.2cc of local anesthetic solution is deposited.
• The needle is withdrawn and recapped.
Successful execution of this technique results in
anesthesia of the buccal soft tissue of the
mandibular molar region.
15. Figure 19 A:Location of the buccal nerve. B: The tissue just distal
and buccal to the last molar tooth is the target area for injection.
16. Gow-Gates Technique
• The Gow-Gates technique or third division nerve block is useful
alternative to the inferior alveolar nerve block
• it is often used when the latter fails to provide adequate
anesthesia.
• Advantages of this technique versus the inferior alveolar technique
are its low failure rate and low incidence of positive aspiration.
• The Gow-Gates technique anesthetizes the auriculotemporal,
inferior alveolar, buccal, mental, incisive, mylohyoid and lingual
nerves. Contraindications to this procedure include acute
inflammation and infection over the site of injection and trismatic
patients. A 25 gauge long needle is preferred for this technique.
17. • Technique-
• The patient should be in the semisupine position. The right
handed operator should be in the eight o’clock position
whereas the left handed operator should be in the four
o’clock position.
• The target area for this technique is the neck of the condyle
below the area of insertion of the lateral pterygoid muscle.
A retraction instrument is used to retract the cheek.
• The patient is asked to open maximally and the
mesiolingual cusp of the maxillary 2nd molar on the side of
desired anesthesia is identified.
• The insertion site of the needle will be just distal to the
maxillary 2nd molar at the level of the mesiolingual cusp.
• Bring the needle to the insertion site in a plane that is
parallel to an imaginary line drawn from the intertragic
notch to the corner of the mouth on the same side as the
injection (Fig. 20, A and B).
18. • The orientation of the bevel of the needle is not important in this
technique. Advance the needle through soft tissue approximately
25mm until bone is contacted. This is the neck of the condyle. Once
bone is contacted, withdraw the needle one millimeter and
aspirate. Redirect the needle superiorly and reaspirate. If aspiration
in two planes is negative, slowly inject one cartridge of local
anesthetic solution over the course of one minute. Successful
execution of this technique provides anesthesia to the ipsilateral
mandibular teeth up to the midline, and associated buccal and
lingual hard and soft tissue. The anterior two thirds of the tongue,
floor of the mouth, skin over the zygoma, posterior aspect of the
cheek and temporal region on the ipsilateral side of injection are
also anesthetized.1,8
19. Figure 20 A: The patient is asked to open mouth maximally. The mesiolingual
cusp of the maxillary 2nd molar is the reference point for the height of the
injection. B: The needle is then moved distally and is held parallel to an
imaginary line drawn from the intertragic notch to the corner of the mouth
20.
21. Vazirani-Akinosi Closed Mouth
Mandibular Block
• The Vazirani-Akinosi closed mouth mandibular block is a useful
technique for patients with limited opening due trismus or
ankylosis of the temporomandibular joint.
• Limited mandibular opening precludes the administration of the
inferior alveolar nerve block or use of the Gow-Gates technique
both of which require the patient to be open maximally.
• Other advantages to this technique are the minimal risk of trauma
to the inferior alveolar nerve, artery, vein, and pterygoid muscle,
low complication rate and minimal discomfort upon injection.
• Contraindications to this technique are acute inflammation and
infection in the pterygomandibular space, deformity or tumor in the
maxillary tuberosity region or an inability to visualize the medial
aspect of the ramus.
• A 25 gauge long needle is preferred for this technique.
22. • Technique-
• The patient should be in the semisupine position. The right handed
operator should be in the eight o’clock position whereas the left
handed operator should be in the four o’clock position.
• The gingival margin above the maxillary 2nd and 3rd molars and
the pterygomandibular raphae serve as landmarks for this
technique.
• A retraction instrument is used to stretch the cheek laterally.
• The patient should occlude gently on the posterior teeth. The
needle is held parallel to the occlusal plane at the level of the
gingival margin of the maxillary 2nd and 3rd molars.
• The bevel is directed away from the bone facing the midline.
• The needle is advanced through the mucous membrane and
buccinator muscle to enter the pterygomandibular space.
23. • The needle is inserted to approximately one half to three quarters
of its length.
• At this point the needle will be in the midsection of the
ptyerygomandibular space.
• Aspirate and if negative, one cartridge of local anesthetic solution
is deposited over the course of one minute.
• Diffusion and gravitation of the local anesthetic solution will
anesthetize the lingual and long buccal nerves in addition to the
inferior alveolar nerve.
• Successful execution of this technique provides anesthesia of the
ipsilateral mandibular teeth up to the midline, and associated
buccal and lingual hard and soft tissue. The anterior two thirds of
the tongue and floor of the mouth are also anesthetized.9,10
24.
25.
26. Mental Nerve Block
• The mental nerve block is indicated for
procedures where manipulation of buccal soft
tissue anterior to the mental foramen is
necessary.
• Contraindications to this technique are acute
inflammation and infection over the injection
site.
• A 25 or 27 gauge short needle is preferred for this
technique.
27. • Technique-
• The patient should be in the semisupine position. The
right handed operator should be in the eight o’clock
position whereas the left handed operator should be in
the four o’clock position.
• The target area is the height of the mucobuccal fold
over the mental foramen (Fig. 21, A and B).
• The foramen can be manually palpated by applying
gentle finger pressure to the body of the mandible in
the area of the premolar apicies.
• The patient will feel slight discomfort upon palpation of
the foramen.
•
28. • Use a retraction instrument to retract the soft
tissue.
• The needle is directed toward the mental
foramen with the bevel facing the bone.
• Penetrate the soft tissue to a depth of five
millimeters, aspirate and inject approximately
0.6cc of anesthetic solution.
• Successful execution of this technique results in
anesthesia of the buccal soft tissue anterior to
the foramen, lower lip and chin on the side of the
injection.1
29. Figure 21, A: Location of the mental and incisive nerves.
Figure 21, B: Block of the mental and incisive nerves: The needle is inserted at
the height of the mucobuccal fold over the mental foramen for both the
mental nerve block and incisive nerve block.
30. Incisive Nerve Block
• The incisive nerve block is not as frequently employed
in clinical practice however it proves very useful when
treatment is limited to mandibular anterior teeth and
full quadrant anesthesia is not necessary.
• The technique is almost identical to the mental nerve
block with one additional step. Both the mental and
incisive nerves are anesthetized using this technique.
• Contraindications to this technique are acute
inflammation and infection at the site of injection.
• A 25 or 27 gauge short needle is preferred for this
technique.
31. • Technique-
• The patient should be in the semisupine position. The right handed
operator should be in the eight o’clock position whereas the left
handed operator should be in the four o’clock position.
• The target area is the height of the mucobuccal fold over the
mental foramen (See Fig. 21, B).
• Identify the mental foramen as previously described. Give the
patient a mental nerve block as described above and apply digital
pressure at the site of injection during administration of anesthetic
solution.
• Continue to apply digital pressure at the site of injection two to
three minutes after the injection is complete to aid the anesthetic
in diffusing into the foramen.
• Successful implementation of this technique provides anesthesia to
the premolars, canine, incisor teeth, lower lip, skin of the chin, and
buccal soft tissue anterior to the mental foramen.
32. Figure 21, B: Block of the mental and incisive nerves: The needle
is inserted at the height of the mucobuccal fold over the mental
foramen for both the mental nerve block and incisive nerve
block.