Lagi cerita tentang mandibular LA

Bismillah...

Kalau tersilap dalam anesthesize orang mc mne?

-too deep injection may cause transient hemifacial paralysis Facial and Palsy.

-kalau pg dalam sgt nti boleh reach parotid gland..kalau dah sampai tahap ini memang dah posterior sangat..huhu

so apa masalahnya?
-nti kena kat facial nerve..bukan IDN so sebab tu jadi facial palsy.

-too superficial injection will not work..makanya: bersederhanalah:)

Bilateral anesthesia in the mandible

It is preferable to avoid bilateral ID and lingual blocks. Use combinations of different technique whenever possible.

x digalakkan buat untuk pediatric patient sbb he may bite his tongue or lips and make trauma to himself.

nerve yang supply motor innervation to the tongue is hypoglossal nerve bukan lingual nerve.

bila buat bilateral block to the ID nerve, lingual nerve will be anesthesized so if the patient is a child , there maybe a risk of trauma to his lips, but in adult no problem:)

scienctifically, there is no any medical contraindication to do bilateral ID block.

Mental block(incisive block)

aim: nak anesthesize insicive nerve bukan mental nerve
sbb mental nerve dah anesthesized waktu buat ID block lagi.

location of mental foramen: between 4 and 5
it is given to avoid giving ID block.

Technique
*put the needle in 45 at the depth of vestibule between 4 and 5
* insert the needle until touch the bone.
*go little bit away from the bone
*give infiltration: 1 ml of anesthesia

Anesthesia of incisor teeth.

Infiltration sama macam maxilla.
-anesthesia of incisor teeth is done by infiltration because the bone in that area is thin.

-kalau nak cabut gigi depan, kena bagi infiltration and kena bagi juga ID block that you give posteriorly

-infiltration dah mencukupi tapi kalau dah bagi ID block kena bagi infiltration jugak la..

cross innervation: central and lateral incisors is innervated from both sides left and right.

Mandibular anesthesia in chlidren.

children buccal plate of bone is much less dense than that of adults.

great variation: xsure sama ada infitration cukup atau x so kita guna :

rule of 10

1) each tooth is allocated a score ( A=1, B=2, C=3, D=4, E=5)

2)add the score to the most distal tooth to be restored  to the child's age (rounded up to the nearest year)

3) _> 10: ID block is indicated
4)_< 10 infiltration is suffiecient

Example:

A 4-years old child needs to extract B & E
The score of the most distal tooth 5 + 4= 9 ( 9<10~ infiltration is sufficient)

This rule is not a must just nak bg senang je.

kalau score 9 nak buat ID block pun okay je tp better bg infiltration  sbb lagi convenient.

Anesthesia of surrounding gingivae.

simple procedures:
* Infiltration in the sulcus
* Infiltration in the gingival papillae

more extensives procedures
*long buccal block
*lingual nerve block.

Long buccal nerve

Branches from the mandibular nerve high in the infratemporal fossa.

Crosses the anterior aspect of the ramus from medial to lateral in the coronoid notch region.

can be anesthesized by:
* block technique distobuccal to the third molar
* infiltration opposite to the target tooth.

kalau simple procedure mcm small procedures in the gingiva, kita kena bagi long buccal block, but not ID sbb ia utk bone.

Lingual nerve
 usually blocked with ID injection.

you anesthesize the lingual nerve when you do ID block as they are in same space.

its terminal branches can be anesthesized by infiltration in the lingual sulcus opposite to the target tooth