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بســم اللَـــه الرحمــن الرحيـــم

بســم اللَـــه الرحمــن الرحيـــم. Prof.Dr.Ragab Shaaban. Local Analgesia In Dentistry. Maxillary nerve block. Intraoral approach. Nerve anesthetized. Area anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of anesthesia

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بســم اللَـــه الرحمــن الرحيـــم

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  1. بســم اللَـــه الرحمــن الرحيـــم

  2. Prof.Dr.Ragab Shaaban

  3. Local Analgesia In Dentistry

  4. Maxillary nerve block Intraoral approach

  5. 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. maxillary nerve block

  6. 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. maxillary nerve block

  7. 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 maxillary nerve block

  8. Maxillary nerve blockhigh 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 2 3 4

  12. Infraorbital nerve block

  13. Maxillary nerve block Extraoral technique

  14. 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. Maxillary nerve block

  15. Landmarks 1 1 2 4 3

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

  22. Inferior alveolar nerve blockIndirect 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

  27. Inferior alveolar nerve block

  28. Inferior alveolar nerve block

  29. Inferior alveolar nerve block

  30. Technique of injection

  31. III. PROPER INJECTION PROCEDURES B- REGIONAL OR BLOCK ANESTHESIA: a- Block anesthesia in the mandible: Errors in needle insertion: • 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: • 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 • 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: • 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 blockdirect 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 blockGow-Gates technique

  39. Inferior alveolar nerve blockGow-Gates technique

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

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