65 Questions
Which area is anesthetized by the Inferior Alveolar Nerve Block?
Mandibular teeth to midline
Which nerve is anesthetized by the Inferior Alveolar Nerve Block?
Inferior alveolar nerve
Which area is not anesthetized by the Inferior Alveolar Nerve Block?
Contralateral molars
For which procedure is the Inferior Alveolar Nerve Block is recommended?
Procedures on multiple mandibular teeth in one quadrant
Which landmark is relevant for the Inferior Alveolar Nerve Block technique?
Coronoid Notch
Which structure is used as a guide for the insertion of the needle during the Inferior Alveolar Nerve Block?
Pterygomandibular Raphe
Which plane is considered during the administration of the Inferior Alveolar Nerve Block?
The Occlusal Plane of the Mandibular Teeth
What complication may arise if the needle is too deep during an inferior alveolar block?
Injection of local anesthetic solution near CN 7 in the parotid gland
What should be done if bone contact is not felt during the administration of an inferior alveolar block?
Retract and reposition the syringe medially
What can overinsertion of the needle during an inferior alveolar block lead to?
Inadvertent anesthesia of the facial nerve
What is the most common cause of inadequate LA with the IAN Block?
Injection too low
Which factor is commonly associated with inadequate LA after an IAN Block?
Accessory innervation
What could lead to inadequate LA with the IAN Block?
Injection too far anterior
How do you correct a low injection?
Reinjecting 5 to 10mm above the previous site
How do you correct an anterior injection?
Retract and reposition the syringe laterally and the needle will go medially, then advance posteriorly
How do you correct accessory innervation during a Bifid IAN?
- Inject lower/higher for a Bifid IAN
How do you not correct accessory innervation during IAN?
Correct by reinjecting 5 to 10mm above the previous site
What is a disadvantage of the Inferior Alveolar Nerve Block (IAN) technique?
Positive aspiration: 10 – 15%
What is the rate of inadequate anesthesia associated with the Inferior Alveolar Nerve Block (IAN)?
31% - 81%
What is a potential complication of the Inferior Alveolar Nerve Block (IAN) in terms of anesthesia distribution?
Partial anesthesia in the presence of bifid IAN and bifid mandibular canals
What is an indication for an Incisive Nerve Block?
Pulpal anesthesia on mandibular teeth anterior to the mental foramen
What is a contraindication for the Incisive Nerve Block?
Infection in the area of injection
What is a disadvantage of the Incisive Nerve Block?
Does not provide lingual anesthesia
What is a potential complication of the Incisive Nerve Block?
Partial anesthesia at the midline
What is a disadvantage of the Buccal Nerve Block technique?
Potential for pain if the needle contacts the periosteum
What is a contraindication for the Buccal Nerve Block?
Infection or acute inflammation in the area of injection
Which nerve is not anesthetized by the Gow-Gates Mandibular Nerve Block?
infraorbital
What percentage of patients experience buccal nerve anesthesia with the Gow-Gates Mandibular Nerve Block?
75%
What is the primary indication for a Gow-Gates Mandibular Nerve Block?
Anesthesia for multiple mandibular teeth
When would a Gow-Gates Mandibular Nerve Block be preferred over a conventional Inferior Alveolar Nerve Block?
When a conventional IAN block is unsuccessful
In which situation is a Gow-Gates Mandibular Nerve Block contraindicated?
Patients who might bite their lip or tongue
Where is the area of insertion for the Gow-Gates Mandibular Nerve Block?
Mucous membrane on mesial of the ramus
What is the relevant line for the insertion of the Gow-Gates Mandibular Nerve Block?
From the intertragic notch to the corner of the mouth
Which area is anesthetized by the Gow-Gates Mandibular Nerve Block?
Mandibular teeth, body, and ramus
Where is the target area for a Gow-Gates Mandibular Nerve Block?
Condylar neck just below the insertion of the lateral pterygoid muscle
At what height should the needle penetrate for a Gow-Gates Mandibular Nerve Block?
Just below maxillary MP cusp of the 2nd molar
Where is the site of penetration for a Gow-Gates Mandibular Nerve Block?
Penetrate just distal to the maxillary 2nd molar
Which area is anesthetized by the Gow-Gates Mandibular Nerve Block?
Mandibular teeth to the midline
Which structures are anesthetized by the Gow-Gates Mandibular Nerve Block?
Buccal mucoperiosteum and mucous membranes on the side of injection and Anterior two thirds of the tongue and floor of the oral cavity
What is a contraindication for the Gow-Gates Mandibular Nerve Block?
Patients with infection or acute inflammation in the area of injection
What is the aspiration rate for the Gow-Gates Mandibular Nerve Block?
2%
What is the success rate of the Gow-Gates Mandibular Nerve Block with experience?
Greater than 95%
What type of canals does the Gow-Gates Mandibular Nerve Block provide successful anesthesia for?
Bifid IAN and bifid mandibular canals
What is a disadvantage of the Gow-Gates Mandibular Nerve Block?
Lingual and lower lip anesthesia is uncomfortable for many patients
What contributes to the longer time of onset of anesthesia with the Gow-Gates Mandibular Nerve Block?
The distance of the nerve trunk from the deposition site
What is a challenge associated with the Gow-Gates Mandibular Nerve Block technique?
The presence of a learning curve
What is not a potential complication of a Gow-Gates Mandibular Nerve Block?
Paresthesia
What nerves are anesthetized by the Vazirani-Akinosi Closed Mouth Block?
Inferior alveolar, incisive, mental, lingual, mylohyoid
Which structures are anesthetized by the Vazirani-Akinosi Closed Mouth Block?
Mandibular teeth to the midline
What soft tissues and periosteum are anesthetized by the Vazirani-Akinosi Closed Mouth Block?
Lingual soft tissues and periosteum
Which area is anesthetized by the Vazirani-Akinosi Closed Mouth Block in front of the mental foramen?
Buccal mucoperiosteum and mucous membrane
What is a contraindication for the Vazirani-Akinosi Closed Mouth Block?
Patients who may bite themselves
What is an indication for the Vazirani-Akinosi Closed Mouth Block?
Inability to visualize IANB landmarks, Limited mandibular opening
Where is the area of insertion for the Vazirani-Akinosi technique?
Mandibular medial soft tissue
What is a potential complication of the Vazirani-Akinosi Closed Mouth Block?
Patients may bite themselves
What is a major advantage of the Vazirani-Akinosi Closed Mouth Block technique?
It is relatively atraumatic
What is a benefit of the Vazirani-Akinosi Closed Mouth Block technique ?
Lower aspiration rate (<10%) than with the inferior alveolar nerve block (10-15%)
What is a disadvantage of the Vazirani-Akinosi Closed Mouth Block technique?
Difficult to visualize the path of the needle and the depth of insertion
What is a potential complication of the Vazirani-Akinosi Closed Mouth Block?
Trauma to the periosteum
What is the primary indication for a Mental Nerve Block?
Soft tissue biopsies
What is a contraindication for a Mental Nerve Block?
Infection in the area of injection
What area is anesthetized by a Mental Nerve Block?
Buccal mucous membrane anterior to the mental foramen to the midline and the skin of the lower lip
What is the amount of local anesthesia in one carpule of 2% Lidocaine with 1:100000 epinephrine?
34mg of Lidocaine and 0.017mg of epinephrine
What is the limit of vasoconstrictor for a cardiac patient when using local anesthesia?
0.04mg
What is the amount of vasoconstrictor in one carpule of 2% Lidocaine with 1:100000 epinephrine?
0.017mg of epinephrine
Study Notes
Inferior Alveolar Nerve Block
- Anesthetizes the mandible, lower teeth, and half of the tongue.
- The inferior alveolar nerve is the primary nerve anesthetized.
- The buccal mucosa in the molar area is not anesthetized.
- Recommended for dental procedures involving lower teeth extraction.
- The occlusal plane and pterygomandibular raphe are relevant landmarks.
- The mandibular notch serves as a guide for needle insertion.
- The horizontal plane is considered during administration.
- Complications may arise if the needle is too deep, risking damage to adjacent structures.
- If bone contact is not felt, withdraw slightly and redirect the needle.
- Overinsertion can lead to anesthetic diffusion into the mandibular foramen, affecting unintended areas.
- Inadequate local anesthesia is often due to the misplacement of anesthetic solution.
- Radicular anatomy variations can be associated with inadequate anesthesia.
- Accessory innervation from the facial nerve or variations may lead to inadequate anesthesia.
- Low injection correction involves re-injecting at a higher location than original.
- Anterior injections can be corrected by adjusting the angle of the needle.
- For Bifid IAN, injection at both the medial and lateral sites may be necessary.
- Avoid using supplementary injections along the same path for accessory innervation.
- Disadvantages include potential for inadequate anesthesia and higher failure rates.
- Rates of inadequate anesthesia are around 10-15%.
- Potential complication: incomplete anesthesia of the lingual nerve, leading to discomfort.
Incisive and Buccal Nerve Blocks
- An incisive nerve block is indicated for anterior teeth anesthesia.
- Contraindication includes infections at the injection site.
- Disadvantage includes potential for incomplete anesthesia due to anatomical variations.
- Complications can include hematoma formation and temporary nerve injury.
- Buccal nerve block disadvantages include limited area anesthesia coverage.
- Contraindications for buccal nerve block include infections or trauma in the area.
Gow-Gates Mandibular Nerve Block
- Notable for not anesthetizing the buccal nerve in all patients.
- 85% of patients experience buccal nerve anesthesia with this technique.
- Primary indication is for extensive dental procedures on the mandible.
- Preferred over conventional IAN Block for surgeries requiring long-lasting anesthesia.
- Contraindicated in cases of an open infection at the injection site.
- The area of insertion is at the posterior aspect of the mandible.
- The relevant line for insertion is the occlusal plane.
- Anesthetizes the entire mandibular quadrant, including teeth and buccal soft tissue.
- Target area is the neck of the mandibular condyle.
- The needle should penetrate at the height of the maxillary vestibule.
- Site of penetration is located near the maxillary second molar.
- Anesthetizes lower teeth, buccal soft tissues, and some lingual tissues.
- Contraindications include severe trismus or anatomical distortions.
- The aspiration rate stands at approximately 1-2%.
- Success rate increases to 95% with experienced practitioners.
- Effective for accessing both molars and premolars.
- Disadvantages include a longer onset time for anesthesia.
- Challenges include accurately locating the target site.
Vazirani-Akinosi Closed Mouth Block
- Anesthetizes the inferior alveolar nerve and lingual nerve.
- Targets the posterior mandible, including molars and associated soft tissues.
- Soft tissues, periosteum, and lower lip anterior to the mental foramen are also anesthetized.
- Contraindication includes patients with limited mouth opening.
- Indicated in patients with difficulty achieving traditional block methods.
- The area of insertion is the maxillary tuberosity region.
- Potential complications include hematoma or accidental intravascular injection.
- Major advantage is that the technique allows access with the mouth closed.
- Benefits include a lower risk of complications related to needle insertion.
- Disadvantage includes potential for delayed onset of anesthesia.
Mental Nerve Block
- Primary indication is for anesthesia of the mental nerve and lip area.
- Contraindicated in cases of infection or tumor in the area.
- Anesthetizes the lower lip and adjacent gingival tissue.
Local Anesthesia Dosages
- A carpule of 2% Lidocaine with 1:100,000 epinephrine contains 36 mg of lidocaine.
- Cardiac patients should limit vasoconstrictors to 0.04 mg.
- One carpule of 2% Lidocaine with 1:100,000 epinephrine contains 0.018 mg of epinephrine.
Test your knowledge of the nerves anesthetized during an inferior alveolar nerve block with this quiz. Identify the specific nerves and areas of anesthesia for the mandibular teeth, tongue, and oral cavity.
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