essay 12 - regional block Anaesthesia of the mandible (intra- and extraoral) . Anatomic and topographic features. Techniques

describe mandibular nerve block

• anesthetises the mandibular branch of the trigeminal nerve

1. intraoral methods; manual or visual

2. extra oral methods

What are Manual Intraoral Methods

• it is where we use the operator's finger to palpate anatomical structures

list the manual intraoral methods

• inferior alveolar nerve block (halsted)

• gow gates

• akinosi - vazirani

describe inferior alveolar nerve block (Halsted)

• Patient = semi supine. Wide open mouth

• procedure:

1. retract cheek laterally

2. palpate the coronoid notch with your thumb

3. insert needle 1CM above mandibular molar occlusal plane, the lateral pterogroid mandibular raphe

4. advance needle ~20-25mm until bone is contacted

5. withdraw 1mm, aspirate

6. slowly inject

describe Gow- gates

• nerves anaesthetised - (cut off in the picture) auriculotemporal

• Patient = wide open mouth, Extended neck

• procedure:

1. ask the patient to open mouth as wide as possible

2. retract cheek

3. locate the mesial cusp of Maxillary second molar (intraoral landmark)

4. insert needle distal to second molar at the height of the mesolingual cusp

5. aim for neck of condyle (needle directed toward tragus)

6. advanced needle until bone is gently contacted

7. withdraw slightly, aspirate

8. inject

describe akinosi-vazirani

• Patient = head tilted backwards and teeth closed gently

• procedure:

1. ask the patient to gently close teeth

2. retract cheek; locate maxillary tuberosity

3. insert needle at Mucogingival junction above the mandibular 3rd molar area

4. keep the needle parallel to the maxillary occlusal plane

5. advance ~25mm Without contacting bone

6. aspirate

7. aspirate inject slowly

What are visual methods

• without palpation of anatomical structures

list of visual methods

• Torusal anesthesia ( Weisbrem)

• Mandibular anesthesia (Levit)

describe the Torusal anesthesia (weisbrem) technique

Describe the Mandibular anesthesia (Levit) technique

other visual methods that weren't mentioned (look into if you have time)

• long buccal nerve block

• mental and incisive nerve block

• Dr G said it's not necessary for erin

list the extra oral methods of regional block anaesthesia of the mandible

• Mandibular incisura approach (Berscher-Dubov-Uvarov)

• Submandibular approach

• Posterior mandibular approach (Pekkert-Wustrow)

• Anterior mandibular approach (Fetissov)

• Basal anesthesia (foramen ovale area)

Describe Mandibular incisura approach (Berscher-Dubov-Uvarov)

Describe Submandibular approach

describe posterior mandibular approach (Pekkert-wustrow)

describe Anterior Mandibular approach (Fetissov)

describe basal anesthestia (foramen ovale area)