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Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
1.  Main	
  Trunk	
  
2.  Nervous	
  Spimosum	
  
3.  Nerve	
  to	
  medial	
  pterygoid	
  
4.  Anterior	
  Division	
  
1.  N.	
  to	
  Temporalis	
  msc.	
  
2.  N.	
  to	
  Masse?er	
  msc.	
  	
  
3.  N.	
  to	
  Lateral	
  Pterygoid	
  msc.	
  
4.  Long	
  Buccal	
  N.	
  
5.  Posterior	
  Division	
  
1.  Auriculo-­‐temporal	
  N.	
  
2.  Lingual	
  Nerve	
  
3.  Inferior	
  Alveolar	
  N.	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Mandibular	
  
anethesia	
  
InfiltraJon	
  
anesthesia	
  
Anterior	
  labial	
  
infl	
  anesth	
  
Anterior	
  lingual	
  
inf	
  anesth	
  
Long	
  buccal	
  inf	
  
anesth	
  
Nerve	
  block	
  
anesthesia	
  
IA	
  and	
  L	
  NB	
  
Mental	
  NB	
  
Long	
  Buccal	
  NB	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Chair	
  posiJon	
  
•  DenJst	
  posiJon	
  
•  Syringe	
  
•  Needle	
  
•  Areas/Nerves	
  to	
  be	
  anestheJzed	
  -­‐	
  Landmarks	
  
•  Point	
  of	
  inserJon	
  
•  DirecJon	
  of	
  injecJon	
  
•  Checking	
  the	
  anesthesia	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Standard	
  technique	
  
•  Gaw-­‐Gates	
  Technique	
  
•  Akinozi	
  Technique	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Aim	
  
– To	
  deposit	
  the	
  anestheJc	
  soluJon	
  in	
  close	
  vicinity	
  
to	
  the	
  Inferior	
  alveolar	
  nerve	
  just	
  before	
  its	
  entry	
  
to	
  the	
  mandibular	
  foramen	
  
– To	
  deposit	
  the	
  anestheJc	
  soluJon	
  in	
  close	
  vicinity	
  
to	
  the	
  lingual	
  nerve	
  as	
  it	
  pass	
  anterior	
  and	
  medial	
  
to	
  the	
  IAN	
  
	
  
	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Chair	
  posi*on	
  
•  Den*st	
  posi*on	
  
•  Syringe	
  :	
  AspiraJng	
  syringe	
  
•  Needle	
  
•  Nerves	
  to	
  be	
  anestheJzed	
  
•  Areas	
  to	
  be	
  anestheJzed	
  
•  landmarks	
  
•  Point	
  of	
  inserJon	
  
•  DirecJon	
  of	
  injecJon	
  
•  Checking	
  the	
  anesthesia	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Pa*ent	
  posi*on	
  
•  Head	
   ,	
   neck	
   and	
   trunk	
   on	
   the	
  
same	
  straight	
  line	
  
•  The	
  back	
  of	
  the	
  chair	
  is	
  Jlted	
  so	
  
that	
   it	
   make	
   a	
   45	
   degree	
   angle	
  
with	
  the	
  floor	
  
•  So	
  that	
  when	
  the	
  paJent	
  open	
  his	
  
mouth	
   the	
   occlusal	
   plane	
   of	
   the	
  
mandibular	
   teeth	
   becomes	
  
parallel	
  to	
  	
  the	
  floor	
  
•  The	
   occlusal	
   plan	
   of	
   mandibular	
  
teeth	
   near	
   to	
   the	
   operator’s	
  
elbow	
  
Den*st	
  posi*on	
  
•  Right	
  side:	
  
–  From	
  infront	
  and	
  to	
  the	
  right	
  
•  LeY	
  side:	
  
–  From	
  infront	
  and	
  to	
  the	
  right	
  
using	
  
•  Cross	
  hand	
  technique	
  
•  Using	
  leY	
  hand	
  
–  From	
  right	
  rear	
  posiJon	
  using	
  
•  From	
  behind	
  technique	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Chair	
  posiJon	
  
•  DenJst	
  posiJon	
  
•  Syringe	
  :	
  Aspira*ng	
  syringe	
  
•  Needle	
  
•  Nerves	
  to	
  be	
  anestheJzed	
  
•  Areas	
  to	
  be	
  anestheJzed	
  
•  landmarks	
  
•  Point	
  of	
  inserJon	
  
•  DirecJon	
  of	
  injecJon	
  
•  Checking	
  the	
  anesthesia	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Chair	
  posiJon	
  
•  DenJst	
  posiJon	
  
•  Syringe	
  :	
  AspiraJng	
  syringe	
  
•  Needle	
  :	
  Long	
  Needle	
  
•  Nerves	
  to	
  be	
  anestheJzed	
  
•  Areas	
  to	
  be	
  anestheJzed	
  
•  landmarks	
  
•  Point	
  of	
  inserJon	
  
•  DirecJon	
  of	
  injecJon	
  
•  Checking	
  the	
  anesthesia	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland	
  DVD	
  of	
  Head	
  and	
  Neck	
  Anatomy	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland	
  DVD	
  of	
  Head	
  and	
  Neck	
  Anatomy	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland	
  DVD	
  of	
  Head	
  and	
  Neck	
  Anatomy	
  
Mand	
  	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland	
  DVD	
  of	
  Head	
  and	
  Neck	
  Anatomy	
  
MP	
  
Msc	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland	
  DVD	
  of	
  Head	
  and	
  Neck	
  Anatomy	
  
B	
  Msc	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland	
  DVD	
  of	
  Head	
  and	
  Neck	
  Anatomy	
  
IAN	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland	
  DVD	
  of	
  Head	
  and	
  Neck	
  Anatomy	
  
IAN	
   LN	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Ocland	
  DVD	
  of	
  Head	
  and	
  Neck	
  Anatomy	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Chair	
  posiJon	
  
•  DenJst	
  posiJon	
  
•  Syringe	
  
•  Needle	
  
•  Nerves	
  to	
  be	
  anesthe*zed	
  
–  Incisive	
  Nerve	
  
–  Mental	
  nerve	
  
–  Inferior	
  alveolar	
  nerve	
  
–  Lingual	
  nerve	
  
•  Areas	
  to	
  be	
  anestheJzed	
  
•  landmarks	
  
•  Point	
  of	
  inserJon	
  
•  DirecJon	
  of	
  injecJon	
  
•  Checking	
  the	
  anesthesia	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Chair	
  posiJon	
  
•  DenJst	
  posiJon	
  
•  Syringe	
  
•  Needle	
  
•  Nerves	
  to	
  be	
  anestheJzed	
  
•  Areas	
  to	
  be	
  anesthe*zed	
  
–  All	
  the	
  pulp	
  and	
  invesJng	
  structures	
  of	
  lower	
  posterior	
  teeth	
  in	
  the	
  side	
  of	
  anesthesia	
  
–  Buccal	
  	
  mucoperiosteum	
  of	
  the	
  anterior	
  teeth	
  and	
  premolars	
  
–  The	
  lingual	
  mucoperiosteum	
  of	
  the	
  same	
  side	
  
–  Floor	
  of	
  the	
  mouth	
  of	
  the	
  same	
  side	
  
–  Half	
  the	
  tongue	
  of	
  the	
  same	
  side	
  
•  landmarks	
  
•  Point	
  of	
  inserJon	
  
•  DirecJon	
  of	
  injecJon	
  
•  Checking	
  the	
  anesthesia	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Chair	
  posiJon	
  
•  DenJst	
  posiJon	
  
•  Syringe	
  
•  Needle	
  
•  Nerves	
  to	
  be	
  anestheJzed	
  
•  Areas	
  to	
  be	
  anestheJzed	
  
•  landmarks	
  
•  Point	
  of	
  inserJon	
  
•  DirecJon	
  of	
  injecJon	
  
•  Checking	
  the	
  anesthesia	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Landmarks:	
  
– SoY	
  Jssue	
  landmarks:	
  
•  Muccobuccal	
  fold	
  
•  Buccal	
  pad	
  of	
  fat	
  
•  Retromolar	
  area	
  –	
  triangle	
  
•  Pterygomandibular	
  raphe	
  
	
  
•  Landmarks:	
  
– Bony	
  landmarks:	
  
•  External	
  oblique	
  ridge	
  
•  Internal	
  oblique	
  ridge	
  
•  Anterior	
   border	
   of	
   the	
  
ramus	
  
•  Coronid	
  process	
  
•  Coronoid	
  notch	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  SoY	
  Jssue	
  landmarks	
   •  Bony	
  landmarks	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Chair	
  posiJon	
  
•  DenJst	
  posiJon	
  
•  Syringe	
  
•  Needle	
  
•  Nerves	
  to	
  be	
  anestheJzed	
  
•  Areas	
  to	
  be	
  anestheJzed	
  
•  landmarks	
  
•  Point	
  of	
  inser*on	
  
•  Direc*on	
  of	
  injec*on	
  
•  Checking	
  the	
  anesthesia	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Right	
  handed	
  operator	
  
•  The	
  operator	
  is	
  posiJoned	
  from	
  infront	
  and	
  to	
  the	
  
right	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Narrow	
  angle	
  of	
  flare	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Narrow	
  angle	
  of	
  flare	
  
Direct	
  more	
  anterior	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Wide	
  angle	
  of	
  flare	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Wide	
  angle	
  of	
  flare	
  
Direct	
  more	
  posterior	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Chair	
  posiJon	
  
•  DenJst	
  posiJon	
  
•  Syringe	
  
•  Needle	
  
•  Nerves	
  to	
  be	
  anestheJzed	
  
•  Areas	
  to	
  be	
  anestheJzed	
  
•  landmarks	
  
•  Point	
  of	
  inserJon	
  
•  DirecJon	
  of	
  injecJon	
  
•  Checking	
  the	
  anesthesia	
  
–  SubjecJve	
  findings	
  
•  Numbness	
  of	
  the	
  lower	
  lip	
  	
  
–  ObjecJve	
  findings	
  	
  
•  Probing	
  does	
  not	
  lead	
  to	
  pain	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Right	
  handed	
  operator	
  
	
  The	
  operator	
  is	
  posiJoned	
  on	
  the	
  right	
  front	
  of	
  the	
  
paJent	
  
–  From	
  infront	
  and	
  to	
  the	
  right	
  
•  Cross	
  hand	
  technique	
  
•  LeY	
  hand	
  technique	
  
–  Right	
  rear	
  posiJon	
  
•  From	
  behind	
  technique	
  
	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Cross	
  Hand	
  Technique	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
From	
  Behind	
  Technique	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
LeY	
  Hand	
  Technique	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Too	
  high	
  injec*on	
  
•  Too	
  low	
  injec*on	
  
•  Too	
  deep	
  injec*on	
  
•  Too	
  medial	
  injec*on	
  
–  A n e s t h e s i a	
   o f	
   t h e	
  
auriclotemporal	
   nerve	
   :	
  
Numbness	
  of	
  the	
  ear	
  	
  
–  InjecJon	
   into	
   lateral	
  
pterygoid	
  muscle	
  :	
  Soreness	
  
and	
  trismus	
  	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Too	
  high	
  injec*on	
  
•  Too	
  low	
  injec*on	
  
•  Too	
  deep	
  injec*on	
  
•  Too	
  medial	
  injec*on	
  
•  Failure	
  of	
  anesthesia	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Too	
  high	
  injec*on	
  
•  Too	
  low	
  injec*on	
  
•  Too	
  deep	
  injec*on	
  
•  Too	
  medial	
  injec*on	
  
– Deposited	
  in	
  paroJd	
  gland	
  
–  Temporary	
   facial	
   nerve	
  
paralysis	
  
–  ParoJJs	
  	
  
– D e p o s i t e d	
   i n t o	
   t h e	
  
posterior	
  facial	
  vein	
  :	
  
–  Toxicity	
  
– Deposited	
   into	
   medial	
  
pterygoid	
  muscle	
  
–  Pain	
  
–  Trismus	
  	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Too	
  high	
  injec*on	
  
•  Too	
  low	
  injec*on	
  
•  Too	
  deep	
  injec*on	
  
•  Too	
  medial	
  injec*on	
  
–  D e p o s i t e d	
   i n t o	
   t h e	
  
constrictor	
   muscle	
   of	
  
pharynx	
  :	
  disphagya	
  
	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Too	
  high	
  injecJon	
  
–  Anesthesia	
  of	
  the	
  auriclotemporal	
  nerve	
  :	
  Numbness	
  of	
  the	
  ear	
  	
  
–  InjecJon	
  into	
  lateral	
  pterygoid	
  muscle	
  :	
  Soreness	
  and	
  trismus	
  	
  
•  Too	
  low	
  injecJon:	
  	
  
–  Failure	
  of	
  anesthesia	
  
•  Too	
  deep	
  injecJon:	
  
–  Deposited	
  in	
  paroJd	
  gland	
  
•  Temporary	
  facial	
  nerve	
  paralysis	
  
•  ParoJJs	
  	
  
–  Deposited	
  into	
  the	
  posterior	
  facial	
  vein	
  :	
  
•  Toxicity	
  
–  Deposited	
  into	
  medial	
  pterygoid	
  muscle	
  
•  Pain	
  
•  Trismus	
  	
  
•  Too	
  medial	
  injecJon	
  
–  Deposited	
  into	
  the	
  constrictor	
  muscle	
  of	
  pharynx	
  :	
  disphagya	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  This	
  technique	
  was	
  introduced	
  in	
  1973	
  by	
  the	
  Australian	
  
operator	
  Dr.	
  George	
  Gow-­‐gates	
  
•  It	
  provides	
  sensory	
  anesthesia	
  to	
  all	
  branches	
  of	
  the	
  
Posterior	
  Division	
  and	
  Buccal	
  nerve	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  This	
   technique	
   was	
   reported	
   in	
   1977	
   by	
   Dr.	
  
Joseph	
  Akinosi	
  
•  The	
   main	
   advantage	
   is	
   that	
   it	
   could	
   be	
  
administrated	
   to	
   paJents	
   with	
   very	
   limited	
  
mouth	
  opening	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  0.2	
  ml	
  of	
  anestheJc	
  soluJon	
  is	
  deposited	
  at	
  the	
  apex	
  of	
  
the	
  retromolar	
  triangle	
  between	
  the	
  external	
  and	
  internal	
  
oblique	
  ridges	
  
•  Point	
  of	
  inserJon	
  
–  apex	
   of	
   the	
   retromolar	
   triangle	
   between	
   the	
   external	
   and	
  
internal	
  oblique	
  ridges	
  	
  
•  DirecJon	
  of	
  injecJon	
  
–  Parallel	
  to	
  the	
  occlusal	
  plane	
  from	
  the	
  same	
  side	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
•  Technique	
  
– The	
   same	
   technique	
   as	
   the	
   inferior	
   alveolar	
   nerve	
   is	
  
followed	
   except	
   that	
   the	
   point	
   of	
   inserJon	
   is	
   just	
  
anterior	
  to	
  the	
  index	
  finger	
  or	
  the	
  area	
  palpated	
  with	
  
the	
  syringe	
  oriented	
  over	
  the	
  teeth	
  of	
  the	
  same	
  side	
  to	
  
be	
  injected	
  and	
  parallel	
  to	
  the	
  occlusal	
  plane.	
  
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
Thank	
  You	
  

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Mandibular teeth anesthetic block techniques

  • 1. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY 1.  Main  Trunk   2.  Nervous  Spimosum   3.  Nerve  to  medial  pterygoid   4.  Anterior  Division   1.  N.  to  Temporalis  msc.   2.  N.  to  Masse?er  msc.     3.  N.  to  Lateral  Pterygoid  msc.   4.  Long  Buccal  N.   5.  Posterior  Division   1.  Auriculo-­‐temporal  N.   2.  Lingual  Nerve   3.  Inferior  Alveolar  N.  
  • 2. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Mandibular   anethesia   InfiltraJon   anesthesia   Anterior  labial   infl  anesth   Anterior  lingual   inf  anesth   Long  buccal  inf   anesth   Nerve  block   anesthesia   IA  and  L  NB   Mental  NB   Long  Buccal  NB  
  • 3. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Chair  posiJon   •  DenJst  posiJon   •  Syringe   •  Needle   •  Areas/Nerves  to  be  anestheJzed  -­‐  Landmarks   •  Point  of  inserJon   •  DirecJon  of  injecJon   •  Checking  the  anesthesia  
  • 4. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 5. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Standard  technique   •  Gaw-­‐Gates  Technique   •  Akinozi  Technique  
  • 6. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 7. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 8. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Aim   – To  deposit  the  anestheJc  soluJon  in  close  vicinity   to  the  Inferior  alveolar  nerve  just  before  its  entry   to  the  mandibular  foramen   – To  deposit  the  anestheJc  soluJon  in  close  vicinity   to  the  lingual  nerve  as  it  pass  anterior  and  medial   to  the  IAN      
  • 9. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 10. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Chair  posi*on   •  Den*st  posi*on   •  Syringe  :  AspiraJng  syringe   •  Needle   •  Nerves  to  be  anestheJzed   •  Areas  to  be  anestheJzed   •  landmarks   •  Point  of  inserJon   •  DirecJon  of  injecJon   •  Checking  the  anesthesia  
  • 11. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Pa*ent  posi*on   •  Head   ,   neck   and   trunk   on   the   same  straight  line   •  The  back  of  the  chair  is  Jlted  so   that   it   make   a   45   degree   angle   with  the  floor   •  So  that  when  the  paJent  open  his   mouth   the   occlusal   plane   of   the   mandibular   teeth   becomes   parallel  to    the  floor   •  The   occlusal   plan   of   mandibular   teeth   near   to   the   operator’s   elbow   Den*st  posi*on   •  Right  side:   –  From  infront  and  to  the  right   •  LeY  side:   –  From  infront  and  to  the  right   using   •  Cross  hand  technique   •  Using  leY  hand   –  From  right  rear  posiJon  using   •  From  behind  technique  
  • 12. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Chair  posiJon   •  DenJst  posiJon   •  Syringe  :  Aspira*ng  syringe   •  Needle   •  Nerves  to  be  anestheJzed   •  Areas  to  be  anestheJzed   •  landmarks   •  Point  of  inserJon   •  DirecJon  of  injecJon   •  Checking  the  anesthesia  
  • 13. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Chair  posiJon   •  DenJst  posiJon   •  Syringe  :  AspiraJng  syringe   •  Needle  :  Long  Needle   •  Nerves  to  be  anestheJzed   •  Areas  to  be  anestheJzed   •  landmarks   •  Point  of  inserJon   •  DirecJon  of  injecJon   •  Checking  the  anesthesia  
  • 14. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Ocland  DVD  of  Head  and  Neck  Anatomy  
  • 15. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Ocland  DVD  of  Head  and  Neck  Anatomy  
  • 16. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Ocland  DVD  of  Head  and  Neck  Anatomy   Mand    
  • 17. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Ocland  DVD  of  Head  and  Neck  Anatomy   MP   Msc  
  • 18. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Ocland  DVD  of  Head  and  Neck  Anatomy   B  Msc  
  • 19. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Ocland  DVD  of  Head  and  Neck  Anatomy   IAN  
  • 20. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Ocland  DVD  of  Head  and  Neck  Anatomy   IAN   LN  
  • 21. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 22. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Ocland  DVD  of  Head  and  Neck  Anatomy  
  • 23. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Chair  posiJon   •  DenJst  posiJon   •  Syringe   •  Needle   •  Nerves  to  be  anesthe*zed   –  Incisive  Nerve   –  Mental  nerve   –  Inferior  alveolar  nerve   –  Lingual  nerve   •  Areas  to  be  anestheJzed   •  landmarks   •  Point  of  inserJon   •  DirecJon  of  injecJon   •  Checking  the  anesthesia  
  • 24. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Chair  posiJon   •  DenJst  posiJon   •  Syringe   •  Needle   •  Nerves  to  be  anestheJzed   •  Areas  to  be  anesthe*zed   –  All  the  pulp  and  invesJng  structures  of  lower  posterior  teeth  in  the  side  of  anesthesia   –  Buccal    mucoperiosteum  of  the  anterior  teeth  and  premolars   –  The  lingual  mucoperiosteum  of  the  same  side   –  Floor  of  the  mouth  of  the  same  side   –  Half  the  tongue  of  the  same  side   •  landmarks   •  Point  of  inserJon   •  DirecJon  of  injecJon   •  Checking  the  anesthesia  
  • 25. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Chair  posiJon   •  DenJst  posiJon   •  Syringe   •  Needle   •  Nerves  to  be  anestheJzed   •  Areas  to  be  anestheJzed   •  landmarks   •  Point  of  inserJon   •  DirecJon  of  injecJon   •  Checking  the  anesthesia  
  • 26. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Landmarks:   – SoY  Jssue  landmarks:   •  Muccobuccal  fold   •  Buccal  pad  of  fat   •  Retromolar  area  –  triangle   •  Pterygomandibular  raphe     •  Landmarks:   – Bony  landmarks:   •  External  oblique  ridge   •  Internal  oblique  ridge   •  Anterior   border   of   the   ramus   •  Coronid  process   •  Coronoid  notch  
  • 27. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  SoY  Jssue  landmarks   •  Bony  landmarks  
  • 28. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Chair  posiJon   •  DenJst  posiJon   •  Syringe   •  Needle   •  Nerves  to  be  anestheJzed   •  Areas  to  be  anestheJzed   •  landmarks   •  Point  of  inser*on   •  Direc*on  of  injec*on   •  Checking  the  anesthesia  
  • 29. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Right  handed  operator   •  The  operator  is  posiJoned  from  infront  and  to  the   right  
  • 30. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 31. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 32. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 33. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 34. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 35. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 36. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 37. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 38. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 39. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Narrow  angle  of  flare  
  • 40. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Narrow  angle  of  flare   Direct  more  anterior  
  • 41. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Wide  angle  of  flare  
  • 42. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Wide  angle  of  flare   Direct  more  posterior  
  • 43. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Chair  posiJon   •  DenJst  posiJon   •  Syringe   •  Needle   •  Nerves  to  be  anestheJzed   •  Areas  to  be  anestheJzed   •  landmarks   •  Point  of  inserJon   •  DirecJon  of  injecJon   •  Checking  the  anesthesia   –  SubjecJve  findings   •  Numbness  of  the  lower  lip     –  ObjecJve  findings     •  Probing  does  not  lead  to  pain  
  • 44. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Right  handed  operator    The  operator  is  posiJoned  on  the  right  front  of  the   paJent   –  From  infront  and  to  the  right   •  Cross  hand  technique   •  LeY  hand  technique   –  Right  rear  posiJon   •  From  behind  technique    
  • 45. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Cross  Hand  Technique  
  • 46. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY From  Behind  Technique  
  • 47. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY LeY  Hand  Technique  
  • 48. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Too  high  injec*on   •  Too  low  injec*on   •  Too  deep  injec*on   •  Too  medial  injec*on   –  A n e s t h e s i a   o f   t h e   auriclotemporal   nerve   :   Numbness  of  the  ear     –  InjecJon   into   lateral   pterygoid  muscle  :  Soreness   and  trismus    
  • 49. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Too  high  injec*on   •  Too  low  injec*on   •  Too  deep  injec*on   •  Too  medial  injec*on   •  Failure  of  anesthesia  
  • 50. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Too  high  injec*on   •  Too  low  injec*on   •  Too  deep  injec*on   •  Too  medial  injec*on   – Deposited  in  paroJd  gland   –  Temporary   facial   nerve   paralysis   –  ParoJJs     – D e p o s i t e d   i n t o   t h e   posterior  facial  vein  :   –  Toxicity   – Deposited   into   medial   pterygoid  muscle   –  Pain   –  Trismus    
  • 51. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Too  high  injec*on   •  Too  low  injec*on   •  Too  deep  injec*on   •  Too  medial  injec*on   –  D e p o s i t e d   i n t o   t h e   constrictor   muscle   of   pharynx  :  disphagya    
  • 52. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Too  high  injecJon   –  Anesthesia  of  the  auriclotemporal  nerve  :  Numbness  of  the  ear     –  InjecJon  into  lateral  pterygoid  muscle  :  Soreness  and  trismus     •  Too  low  injecJon:     –  Failure  of  anesthesia   •  Too  deep  injecJon:   –  Deposited  in  paroJd  gland   •  Temporary  facial  nerve  paralysis   •  ParoJJs     –  Deposited  into  the  posterior  facial  vein  :   •  Toxicity   –  Deposited  into  medial  pterygoid  muscle   •  Pain   •  Trismus     •  Too  medial  injecJon   –  Deposited  into  the  constrictor  muscle  of  pharynx  :  disphagya  
  • 53. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 54. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  This  technique  was  introduced  in  1973  by  the  Australian   operator  Dr.  George  Gow-­‐gates   •  It  provides  sensory  anesthesia  to  all  branches  of  the   Posterior  Division  and  Buccal  nerve  
  • 55. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 56. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 57. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 58. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  This   technique   was   reported   in   1977   by   Dr.   Joseph  Akinosi   •  The   main   advantage   is   that   it   could   be   administrated   to   paJents   with   very   limited   mouth  opening  
  • 59. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 60. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 61. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  0.2  ml  of  anestheJc  soluJon  is  deposited  at  the  apex  of   the  retromolar  triangle  between  the  external  and  internal   oblique  ridges   •  Point  of  inserJon   –  apex   of   the   retromolar   triangle   between   the   external   and   internal  oblique  ridges     •  DirecJon  of  injecJon   –  Parallel  to  the  occlusal  plane  from  the  same  side  
  • 62. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY •  Technique   – The   same   technique   as   the   inferior   alveolar   nerve   is   followed   except   that   the   point   of   inserJon   is   just   anterior  to  the  index  finger  or  the  area  palpated  with   the  syringe  oriented  over  the  teeth  of  the  same  side  to   be  injected  and  parallel  to  the  occlusal  plane.  
  • 63. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 64. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 65. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 66. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY
  • 67. Block Anesthetic Techniques for Mandibular teeth Innervation & Anesthesia - ELHAWARY Thank  You