Mandibular Anesthesia Techniques

Bismillah..

Nak buat anesthesia ni mmg kena banyak practice. Bukan sekadar teori practice makes perfect :)

Infiltration techniques tak berkesan pun kat mandible org dewasa sbb mandible dyorg ada dense cortical bone. kalau maxilla lain la sbb dia cancellous bone je. Infiltration may be used for lower incisors.

Guna kat budak boleh la sbb bone dia thinner lagi.

Nerve block technique: hitting the area where the root of the nerves gets off- will anesthesize the nerve and all its branches.

kat bahagian mana IDN free from bone?
pterygomandibular foramen
-jadi kalau kita hit the nerve at that area before it gets into the foramen, we will anesthesize the main trunk and nerve after the trunk.

more challenging than maxillary anesthesia

requires good knowledge of local anatomy

nerve blocks are utilized to anesthesize IAN, lingual nerve, buccal nerve

provide anesthesia to the pulpal, alveolar, lingual and buccal gingival tissue and skin of lower lip and medial aspect of chin on side injected.

Fascial space

fascia ye bukan face..hee

apa tu fascia?
-potential spaces which means they aren't real spaces. bukan empty space
-ada boudaries, maknanya lies within substructures which make that area ease to be isolated from other areas.

jadi..kalau one of these space kena infection habisla yg lain sbb infection will be easily infiltrate to the whole space, but it will be difficult to spread...why????

-each space ada borders or walls that made from muscles or bones, jadi infection stay in place and takes a longer time to go to other place.

Submandibular space

anterior & lateral: medial surface of mandible

posterior: hyoid bone

inferior & lateral: skin, superficial fascia, platysma muslce, and superficial layer of deep cervical fascia.

medial: anterior belly

superior: mylohyoid muscle

gambar screenshot je mampu..hee

Pterygomandibular space.

-is the fascia space that contains the IAN and the lingula borders.

Ant: pterygomandibular raphe and fibers of the superior constrictor and the buccinator muscles inserted in.

Post: parotid gland

Lateral wall: the inner surface of  the ascending ramus

Medial (floor) and deep boundary: medial pterygoid muscle.

medial pterygoid muscle
-origin: medial surface of lateral plate of pterygoid muscle
-insert: angle of mandible( from inside:medially)

the lingual nerve is ada je dalam pterygomandibular space ni..so it will be anesthesized as well when u give the ID block coz it will be escorting the ID nerve.

Roof (superiorly) : lateral pterygoid muscle
note: masseter muscle inserts in the lateral surface of the mandible

Medial: medial pterygoid muscle and above the lateral pterygoid