Nerve Block: Inferior Alveolar: Difference between revisions
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==Procedure== | ==Procedure== | ||
#Preparation | #Preparation | ||
##Place | ##Place patient in seated position or in dental chair so that when his mouth is open, the mandible is parallel to the floor | ||
##Place yourself on the opposite side of the the site being injected | ##Place yourself on the opposite side of the the site being injected | ||
##Consider Topical Anesthetic with lidocaine soaked gauze | ##Consider Topical Anesthetic with lidocaine soaked gauze | ||
Revision as of 07:42, 2 July 2016
Background
- Inferior alveolar nerve provides sensation to all of the teeth on the ipsilateral side of the mandible as well as the lower lip and chin via the mental nerve.
Indications
- Dental pain
- Dentoalveolar trauma
- Dry socket
- Periapical abscess.
- Need to perform painful procedure on mandible or lower lip/chin
Contraindications
- Infection overlying injection site
- Allergy to local anesthetic being used
Equipment Needed
- Topical anesthetic
- Consider soaking Gauze/Cotton in lidocaine to be placed at injection site
- Local anesthetic
- 5-10 mL syringe
- Blunt fill needle
- 25-27ga needle
Procedure
- Preparation
- Place patient in seated position or in dental chair so that when his mouth is open, the mandible is parallel to the floor
- Place yourself on the opposite side of the the site being injected
- Consider Topical Anesthetic with lidocaine soaked gauze
- Injection
- Palpate the retromolar fossa with your thumb
- Place the index finger of the same hand externally over the ramus of the mandible retracting the tissues toward the buccal aspect
- Visualize the pterygomandibular triangle
- Hold the syringe parallel to the occlusal surfaces of the teeth and angle so that the barrel lies between the 1st/2nd premolars of the opposite side
- If a large syringe is being used, consider bending the needle 30 degrees for this approach
- Puncture with the needle 1cm above the occlusal surface of the molars
- Advance the needle until bone is felt
- Inject 1-2cc
- Injecting as your withdraw has the added benefit of including the lingual (ant 2/3 of the tongue)
Complications
- Inadvertent Injection of the partoid gland (may → iatrogenic Bell's Palsy)
- Carotid sheath injection (Horner's from stellate ganglion blockade)
- Carotid artery puncture
- Bleeding
- Pain
- Infection
See Also
References
- Roberts, J. et al. Clinical Procedures in Emergency Medicine 6th Edition. Philadelphia: Elevier/Saunders; 2013