Ch 13: Mandibular Anesthesia (Quiz 9)

inferior alveolar, mental, long buccal

What are the 3 types of mandibular injections?

conventional, unilinear, gow gates, varizani-akinos

What are the 4 types of inferior alveolar blocks (mandibular blocks)?

is not

local infiltration ________ (is or is not) effective in the mandible due to: increased bone density of the cortical plates of the mandible

foramen ovale

What foramen does V3 go through?

inferior alveolar nerve, lingual nerve, long buccal nerve, mental nerve

What are the 4 major branches of V3?

deep

If only tongue is numb after attempting to give an inferior alveolar nerve block that means the lingual nerve was anesthetized and the needle was not __________ enough

mental foramen (usually between apices of 1st and 2nd premolars)

What is the target area for mental nerve block?

vestibule; anterior; posterior

Penetration of the mucosa for mental nerve block is made:

- in-depth of the ________________

- just _____________ or ____________ to neurovascular bundle (palpate)

27 short or 25 long

What needles are used for mental nerve block?

bury the bevel

For mental nerve block how deep is the insertion?

1 cc (1/2 carpule; just enough to see tissue bubble)

How many cc is used for mental nerve block?

pressure

for mental nerve block apply _____________ on area that has ballooned so that the anesthetic goes into the mental foramen

failure

Blocking the Mandibular Division nerves is subject to a

high percentage of _____________

variation of the target zone and difficulty visulizing

What are the 2 most likely reasons of mandibular division nerve block failure?

retromolar triangle (moves in concert with the mandible)

What is the target area of the conventional mandibular block?

medially; laterally; superiorly

The retromolar triangle is defined by the pterygomandibular raphe __________, anterior border of the ramous __________, and hamular notch ____________

coronoid notch

deepest concavity of the anterior border of the ramus

- height of the mandibular foramen

dimple

The target area of a conventional mandibular block is characterized by a _____________ or depression found roughly in the center of the triganle

25 long

What needle is used for conventional mandibular block?

parallel

When giving a conventional mandibular block align barrel of syringe with contralateral premolars ___________ with occlusal plane

2/3 to 3/4 of needle until bone is contacted

How far is the insertion of the needle for a conventional mandibular block?

positive aspiration

a _____________ _____________ is common (10-15%) for conventional mandibular block

3/4 carpule

How much of the carpule is used for conventional nerve block? (the rest is used for long buccal block)

lateral

The point of insertion for a conventional mandibular block is __________ to the pterygomandibular raphe

posterior

The ____________ target zone for the conventional mandibular block is:

- quite large

- generally quite forgiving regarding the precision of needle placement as long as depth is reached

bone

For conventional mandibular block never inject without hitting ________

anterior border of the ramus

Where is the target area for long buccal nerve block?

distal; buccal; parallel; 45

Penetration of the mucosa is for the long buccal nerve block is made:

- ____________ and ____________ to the most distal molar tooth in the arch

- needle ____________ to occlusal plane but buccal to the teeth

- reposition needle if necessary (shallow tissue) = _____ degree angle/laterally

25 long

What needle is used for long buccal nerve block?

bone

For long buccal nerve block insertion is made until ______ is contacted

bury the bevel

How deep is the insertion for long buccal nerve block?

repositioning

___________ needle is often necessary for long buccal nerve block

0.2cc

How many cc is used for long buccal nerve block?

superior

The target zone for gow gates mandibular block differs that it is significantly _____________ to the target zone of the conventional block

experience; slower; aspiration; bifid

The gow gates mandibular block technique has:

- high success rate (>95%) - requires _______________

- ____________ onest of anesthesia = 5-10 minutes (vs. 3-5 min)

- low _____________ rate (2%)

- only way to go get successful anesthesia with ______ inferior alveolar nerve and mandibular canals

lateral side of condylar neck

Where is the target area of the gow gates mandibular block?

distal; mesiolingal; intertragus; corner; 5; 1-2

Penetration of the mucosa for gow gates mandibular block:

- needle placed just ________ to maxillary 2nd molar

- at the height of the tip of the ________________ cups (3rd molar present)

- syringe barrel aligned with the imaginary line between the ____________ notch (injection side) and the __________ of the mouth (opposite side)

- sit patient upright for ___ min with open mouth for __-__ min

25 long

What needle is used for gow gates mandibular block?

3/4 needle (until bone is contacted)

How deep is the insertion of gow gates mandibular block?

bone; anteriory

for gow gates mandibular block make sure ________ is contacted --> if not, retract slightly and redirect needle by moving syringe barrel posteriorly = redirects needle ________________

medial

____________ deflection of the needle during gow gates is usual cause of missing bone

is not

For gow gates orientation of the needle bevel _________ (is or is not) critical

full carupule

How much of the carpule is used for gow gates mandibular block?

1; superior

For the uni-linerar mandibular block it is approx. ____cm ____________ to the target zone of the conventional mandibular block is an area with the inferior alveolar nerve, lingual nerve and long buccal nerve are closest together

parallel, close, straight

For a uni-linear mandibular block the inferior alveolar nerve, lingual nerve and long buccal nerve are running ___________, _________ in proximity and in a ____________ line

1 cm superior to conentional mandibular block target

Where is the target area of the uni-linerar mandibular block?

3; barrel; bone; 2; slowly

Penetration of uni-linear mandibular block:

- ___mm above dimple of posterior triangle

- swing _____ to opposite side (canine/premolar area) --> advance until ______ is contacted

- withdrawl __mm and deposit anesthetic

- _________ withdrawl, depositing remaining carpule (anesthetizes lingual and long buccal)

1/2 to 2/3 needle

How deep is the insertion for uni-linear mandibular block?

3/4 (initially, then as removed remaining amount is deposited)

How much of the carpule is used for uni-linear nerve block?

medial border of ramus (same height as unilateral technique)

Where is the target area for varizani-akinosi block?

occlusion; parallel; mucogingival; lateral; is not

Penetration of the mucosa for varizani-akinosi block:

- mouth is closed; light ___________

- syringe barrel is ___________ to maxillary occlusal plane

- needle is inserted at ____________ junction of maxillary 2nd molar (3rd molar if present) and advanced in a slightly ________ direction

- bone _______ (is or is not) contacted

25 long

What needle is used for varizani-akinosi block?

3/4 needle

How deep is the insertion of the needle for varizani-akinosi block?

varizani-akinosi (away from mandible and faces maxilla)

For all the mandibular blocks the bevel is toward the bone except for which one?

1.8 cc (full carpule)

How many cc is used for varizani-akinosi block?

sit patient upright

What should you do after giving a varizani-akinosi mandibular block?

Insufficient volume of L.A.

What is the most common reason for missing a mandibular block

1.8 cc

How many cc is used for a conventional mandibular block?

delivering L.A. too far away from inferior alveolar nerve

What is the second most common reason for missing a mandibular block?

1; 2/3 - 3/4

For mandibular blocks the needle MUST be advance in the tissue approximately ___ inch or _____ - _____ the length of a long needle

redirect

For mandibular blocks if bone is contacted before reaching the proper depth, you must ______ the needle and advance

too low (below the lingula)

What is the third most common reason for missing a mandibular block?

parallel; 1/2

For mandibular blocks being too low can be avoided by orienting the barrel of syringe __________ with the mandibular occlusal plane and _____ inch above the occlusal plane. Maintain this orientation even when making corrections for depth

iatrogenic bell's palsy (facial nerve paralysis)

occurs with mandibular block if too far anterior

never

____________ deliver anesthetic without contacting bone first

paresthesia

- persistent tingling or numbness

- occurs with mandibular block if needle grazes nerve

- patient feels an electric shock (document)

- usually lasts 3-6 weeks; can last for 6-12 months

- strong association with articaine

4-6

Toxicity:

NEVER administer more than __-__ carpules without calculating patients weight

slowly

Toxicity:

deliver anesthetic __________