The inferior dental nerve block

Bismillah..

The inferior dental nerve block

needle: 35 mm
kenapa panjang sgt???
- because it will go through too many structures "medial pterygoid muscle, buccinator till reaches its space.

The nerve is usually blocked at the mandibular foramen, jadi patient should be seated with the mouth widely open. For the right-handed operator:

right ID block: stand in front of the patient

left ID block: stand behind the patient

kalau left-handed: sebaliknya.

macam mana nak cari pterygomandibular space?
-kena cari landmarks

1)maximum concavity on the anterior and post aspect of the ascending ramus.

2) pterygomandibular raphe

prominent soft tissue band yang connect antara mandible and maxilla

consist of muscular fibers: supr constrictor muscle

buccinator muscle insert in it.

pterygomandibular space:

lateral: ant border of mandible
medial: pterygomandibular raphe

3)buccal pad of fat

4)mandibuar occlusoplane.

place the thumb (intraorally) and index finger (extraorally) of your left hand on the max concavities of the ramus.

kat mne perlu inject local anesthesia?
-inject inside the pterygomandibular space (exactly between the ant border of the mandible & the pterygomandibular raphe) not to the nerve itself, so it will anesthesize the trunk itself.

how does it give its action?
-pterygomandibular space is surrounded by muscle so when injecting a solution to the space it will rach all the tissues in the space.
-sbb tu kalau anesthesize, kita aim to reach the space not the nerve.

Entry point of the needle.

1) the thumb is in the mouth ( ant border of the ramus of mandible)
2) index is outside the mouth on the post border of ramus of mandible
3) injection will be between the raphe and your fingers.

lat to the pterygomandibular raphe

medial to the ascending ramus

at the tip of buccal pad of fat above the mandibular occlusal approx 5-10mm

at the level of the maximum concavities of the ramus. (at the tip of the midpoint of your thumb)

approach from the opposite premolar region.

advance the needle until it touches the bone.

aim to touch bone midway between your thumb and index finger.

aspirate

inject around 2 ml of anesthethic solution (the amount of anesthesia to achieve the block is 2ml

try to give some anesthesia while you are entering or while advancing the needle. this reduces the pain.

wait up until 5 minutes and ask for altered sensation in the lower lip.