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SPECIAL TECHNIQUES

SPECIAL TECHNIQUES. Indication For Special Technique. Infection Pathology Trismus Trauma. Nerve Block Techniques. Extraoral Maxillary Nerve Block Extraoral Infraorbital Nerve Block Extraoral Mandibular Nerve Block. Nerve Block Techniques. Gow-Gates Mandibular Nerve Block

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SPECIAL TECHNIQUES

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  1. SPECIAL TECHNIQUES

  2. Indication For Special Technique Infection Pathology Trismus Trauma

  3. Nerve Block Techniques Extraoral Maxillary Nerve Block Extraoral Infraorbital Nerve Block Extraoral Mandibular Nerve Block

  4. Nerve Block Techniques Gow-Gates Mandibular Nerve Block Akinosi Closed Mouth Mandibular Nerve Block

  5. Infiltration Techniques Periodontal Ligament Intraosseous Mylohyoid Nerve

  6. Gow-Gates Mandibular Block Developed to improve success rate True mandibular nerve block Has a lower rate of positive aspiration (2% vs. 10%-15% for IAN) Technique dependent

  7. Indication For Special Technique Anatomic variation Complete nerve trunk Selective pulpal / soft tissue anesthesia

  8. Gow-Gates Mandibular Block Target Area Neck of condyle, below insertion of lateral pterygoid muscle

  9. Gow-Gates Mandibular Block Landmarks Mesiolingual cusp of maxillary 2nd molar Intertragic notch Corner of the mouth

  10. Gow-Gates Mandibular Block Technique Coordinate intraoral & extraoral landmarks Align barrel of syringe over premolars and with extraoral landmarks

  11. Gow-Gates Mandibular Block Technique (cont.) Penetrate mucosa distil to 2nd molar Advance needle to bone (avg. 25 mm) Aspirate, deposit 1.8 ml of solution slowly

  12. Gow-Gates Mandibular Block Technique (cont.) Patient’s mouth must be fully open during injection and for 1-2 mins afterward May require reinforcement with second injection

  13. Gow-Gates Mandibular Block Complications Hematoma (< 2%) Trismus

  14. Akinosi Closed Mouth Mandibular Block Alternative for mandibular block when limited opening is present ( eg. trismus, closed lock, etc..)

  15. Akinosi Closed Mouth Mandibular Block Advantages Not necessary to open widely High success rate Relatively atraumatic Few complications, few positive aspirations

  16. Akinosi Closed Mouth Mandibular Block Disadvantages Visualization of path and depth of insertion is difficult No bony contact Traumatic if needle hits periosteum

  17. Akinosi Closed Mouth Mandibular Block Target Area Soft tissue medial to ramus Above foramen, below condyle Landmarks Mucogingival junction of maxillary 2nd or 3rd molar Maxillary tuberosity

  18. Akinosi Closed Mouth Mandibular Block Area of insertion Soft tissue overlying medial ramus, adjacent to tuberosity At height of mucogingival junction of maxillary 2nd or 3rd molar

  19. Akinosi Closed Mouth Mandibular Block Technique Retract soft tissues, have patient occlude Apply topical Penetrate to 25 mm, parallel to maxillary occlusal plane, in a posterior and lateral direction

  20. Akinosi Closed Mouth Mandibular Block Technique (cont.) Aspirate, deposit 1.8 ml slowly Motor paralysis will develop first, allowing patient to open more widely

  21. Akinosi Closed Mouth Mandibular Block Complications Hematoma (<10%) Facial nerve paralysis (Bell’s Palsy) Trismus (rare)

  22. Akinosi Closed Mouth Mandibular Block Failures of anesthesia Lateral flaring of mandible Insertion too low Penetration too deep or shallow (adjust for patient size)

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