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بســم اللَـــه الرحمــن الرحيـــم. Prof.Dr.Ragab Shaaban.

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Presentation on theme: "بســم اللَـــه الرحمــن الرحيـــم. Prof.Dr.Ragab Shaaban."— Presentation transcript:

1 بســم اللَـــه الرحمــن الرحيـــم

2 Prof.Dr.Ragab Shaaban

3 Local Analgesia In Dentistry

4 Maxillary nerve block Intraoral approach

5 maxillary nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective The entire maxillary nerve and all its sub- divisions peripheral to site of injection.

6 maxillary nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective According to the technique used: A- high tuberosity tech. B- Greater palatine canal tech.

7 maxillary nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective * When anesthesia for the entire max. nerve is required for extensive surgery. * Presence of infection. * For diagnostic or theraputic purposes

8 Maxillary nerve block high tub. Tech. Greater palatine canal tech.

9 Extraoral maxillary block technques A- infraorbital nerve block B- maxillary nerve block

10 Infraorbital nerve block Extraoral technique

11 Infraorbital nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective 1 23 4

12 Infraorbital nerve block

13 Maxillary nerve block Extraoral technique

14 Maxillary nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective  For extensive surgery.  For all divisions with minimum amount of LA.  When it is difficult to anesthetize a terminal branch.  Diagnostic & theraputic reasons.

15 Landmarks 1 2 34 1

16 Technique

17 Local analgesia Mandibular techniques

18 Techniques of regional analgesia for the mandibular nerve & its subdivisions A- intraoral techniques

19 Nerve supply of the mandible

20 Inferior alveolar nerve block

21  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks. . Indications  Technique.  Symptoms of anesthesia a- subjective b- objective

22 Inferior alveolar nerve block Indirect technique  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective  Mucobuccal fold  Anterior ramus of the mandible  External oplique ridge  Retromolar triangle  Internal oplique ridge  Pterygomandibular ligament  Buccal suking pad  Pterygomandibular space

23 Inferior alveolar nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective *Analgesia for operative dentistry on all mand. Teeth. *Surgery on mand. teeth & supporting structures anterior to the frist molar + lingual NB *Surgery on mand. teeth & supporting strucures posterior to the second bicuspid +lingual NB+ buccal NB. *Diagnostic & therputic purpose

24 Inferior alveolar nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Techniques.  Symptoms of anesthesia a- subjective b- objective  Indirect technique.  Direct technique.  Gaw-Gates technique.  Closed mouth technique.  Extraoral technique.

25 Inferior alveolar nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective

26 Inferior alveolar nerve block

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28

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30 Technique of injection

31 III. PROPER INJECTION PROCEDURES B- REGIONAL OR BLOCK ANESTHESIA: a- Block anesthesia in the mandible: Errors in needle insertion: 1. Too high insertion:  Numbness of the ear as a result of anesthesia of the auriculotemporal nerve.  Post-injection pain & Trismus due to hitting of the insertion of the temporalis or lateral pterygoid.

32 Post-injection pain & Trismus due to hitting of the insertion of the temporalis or lateral pterygoid.

33 B- REGIONAL OR BLOCK ANESTHESIA: a- Block anesthesia in the mandible: Errors in needle insertion: 1. Too high insertion:  Temporary facial paralysis due to dissemination of the solution to the branches of the facial nerve.  Double vision or temporary blindness due to dissemination of the solution through inferior orbital fissure to the lateral rectus muscle or to the optic nerve.  Haematoma in the deep temporal spaces by hitting the pterygoid venous plexus.

34 Errors in needle insertion 1. Too low insertion:  Trismus due to trauma of the medial pterygoid.  Injection into the posterior facial vein.

35 B- REGIONAL OR BLOCK ANESTHESIA a- Block anesthesia in the mandible: Errors in needle insertion: 1. Too medial insertion:  Nausea & vomiting from dissemination of solution to the pharynx.  Dysphagea due to haematoma of the lateral pharyngeal space.

36 Inferior alveolar nerve block direct technique

37 Inferior alveolar nerve block Gaw- Gates techniqe  It is considered a high mandibular block.  Landmarks are : - angle of the mouth. - intertragic notch. - neck of the condyle.

38 Inferior alveolar nerve block Gow-Gates technique

39

40 Closed mouth technique (Vazirani tech.)

41 Causes of failure of local analgesia  Insuffecient knowledge of local anatomy of the region.  Faulty technique.  Individual anatomical variations occuring in different patients.  Intravascular injection.  Needle deflection.  Inflammation.

42 Failure of mandibular anesthsia (Anatomical variations)

43 Causes of failure (Faulty technique)

44 Lingual nerve block

45  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective

46 Lingual nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective The same land- marks of the inferior alveolar nerve block.

47 Lingual nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective For surgery on the anterior 2/3 of the tongue,floor of the mouth and mucous membrane on the lingual side of the mandibule.

48 Lingual nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective

49 Lingual nerve block

50  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective

51 Long buccal nerve block

52  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective

53 Long buccal nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective  External oplique ridge. * Retromolar triangle.

54 Long buccal nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective  External oplique ridge. * Retromolar triangle.

55 long buccal nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective * Surgery on the buccal mucosa. * To supplement the inferior alveolar nerve block.

56 Long buccal nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective

57 Mental nerve block

58  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective a- subjective b- objective

59 Mental nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective * Lower lip. * mucous membrane in the mucobuccal fold anterior to the mental foramen.

60 Mental nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective For surgery on the lower lip or mucous membrane in the mucobuccal fold anterior to the mental foramen.

61 Mental nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective

62 Incisive nerve block

63  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective

64 Incisive nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective The same like mental nerve block.

65 Incisive nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective For anesthesia of the mandibule and labial mandibular structures anterior to the mental foramen and lower lip.

66 Incisive nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective

67 Extraoral mandibular block techniques A- mental & incisive nerve block B-inferior alveolar nerve block C- Mandibular nerve block

68 Mental & incisive nerve block Extraoral techniques

69 Mental & incisive nerve block  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective  Bicuspid teeth  Lower edge of the body of the mand  Supraorbital notch  Infraorbital notch  Pupil of the eye

70 Technique  Nerve anesthetized.  Area anesthetized.  Anatomical landmarks.  Indications.  Technique.  Symptoms of anesthesia a- subjective b- objective  Patient looks forward  An imaginary line drown from supraorbital n.-pupil- infraorbital n., if continued downward will pass through the mental foramen  Midpoint is detected between gingival margine and lower border of the mand.  Ant.&downward insertion with gentle proping

71 Inferior alveolar nerve block Extraoral technique Kurt Thoma

72 Technique  This technique is only used when there is severe limitation of opening of the jaws as with TMJ ankylosis.  Complete asepsis should be considered.

73 Technique  Anteroinferior border of the masseter is located & marketed  A line connecting it with the tragus of the ear is drown and bisected  This midpoint marks the mand. foramen externally  A line is drown down to the inferior border of the mand and parallel to the posterior border of the mand.

74 Technique  Needle is inserted should be parallel to this line and of equal length

75 Mandibular nerve block Extraoral technique

76 Landmarks 1 2 34 1

77 Technique


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