1
Q
what are the three branches of V3
A
- undivided nerve
- anterior division
- posterior division
2
Q
what is involved in the undivided nerve of V3
A
- medial pterygoid branch
- dura mater branch
3
Q
what is involved in the anterior division of V3
A
- lateral pterygoid branch
- masseter muscle branch
- temporal muscle branch
- LONG BUCCAL NERVE
4
Q
what is involved in the posterior division of V3
A
- auriculotemporal branch
- LINGUAL NERVE
- mylohyoid nerve
- INFERIOR ALVEOLAR NERVE
- MENTAL NERVE
- incisive nerve (terminal branches)
5
Q
what are the 4 MAJOR branches of V3
A
- inferior alveolar nerve
- lingual nerve
- long buccal nerve
- mental nerve
6
Q
what are examples of mandibular injections
A
- conventional mandibular block
- Gow-Gates mandibular block
- Uni-linear mandibular block
- Vazirani-akinosi mandibular block
- mental nerve block
- mylohyoid nerve block
7
Q
ALL mandibular nerve blocks use a full carpule EXCEPT __
A
mental & mylohyoid nerve blocks –> use 1.0 cc
8
Q
what is the most challenging area of the orofacial complex to anesthetize
A
inferior alveolar nerve
9
Q
why is the inferior alveolar nerve so difficult to anesthetize
A
- structural complexity of V3
- entire division is freely movable along with the mandibular structures which it innervates
- bone is more compact so local infiltration is NOT effective
10
Q
what does the inferior alveolar nerve provide sensation to
A
- mandibular teeth
- body of the mandible, inferior portion of the ramus
- buccal mucoperiosteum, mucus membrane anterior to the mental foramen
11
Q
the inferior alveolar nerve descends __ and __ across the pterygoid space
A
inferiorly & laterally
12
Q
what are the 2 branches that the inferior alveolar nerve forms
A
anteriorly = lingual nerve
posteriorly = mylohyoid nerve
13
Q
the inferior alveolar nerve enters the mandible through the ___ and transverse beneath the roots of the mandibular teeth to the ___
A
- mandibular foramen
- mental foramen
14
Q
at the mental foramen the inferior alveolar nerve splits into two branches, what are these two branches?
A
- exiting the foramen = mental nerve
- remaining in the mandible = incisive nerve
15
Q
the incisive nerve can cross the ___ to the opposite ___ and possibly the opposite ___
A
- midline
- incisors
- mandibular foramen
16
Q
the lingual nerve descends ___ and ___ between the ramus and medial pterygoid muscle
A
inferiorly & medially
17
Q
the lingual nerve runs anterior and slightly medial to the ___ & just distal and medial to the ___
A
- inferior alveolar nerve
- third molar
18
Q
the lingual nerve extends inferiorly to the ___
A
tongue
19
Q
what does the lingual nerve provide sensation to
A
- anterior 2/3 of tongue
- floor of mouth
- lingual gingiva
20
Q
the long buccal nerve branches off of ___
A
anterior division of V3
21
Q
the long buccal nerve descends parallel to the ___ and ___
A
- lingual nerve
- inferior alveolar nerve
22
Q
at the ___ the long buccal nerve swings laterally and fans up and out over the area of the buccal mucosa
A
retromolar pad
23
Q
what does the long buccal nerve provide sensory information to
A
- buccal gingiva of molar/premolar area
- skin of the cheek
NO innervation of the lip
24
Q
in order to accomplish restorative and surgival procedures involving the tissues of the MANDIBULAR DIVISION –> the following nerves and their respective branches must be anesthetized USING ONE CARPULE
A
- inferior alveolar nerve
- lingual nerve
- long buccal nerve
25
which nerve provides pulpal innervation to the mandibular teeth?
a - long buccal nerve
b - inferior alveolar nerve
c - lingual nerve
d - nerve to mylohyoid
b - inferior alveolar nerve
26
T/F blocking the mandibular division nerve is subject to a high percentage of success
false - failure
due to dynamic nature of target zone and difficulty in visualization
27
what are the two target zones for the conventional mandibular block
- posterior zone
- anterior zone
28
what is included in the posterior zone of the conventional mandibular block
- inferior alveolar nerve
- lingual nerve
29
what is included in the anterior zone of the conventional mandibular block
- long buccal nerve
- targeted in separate injection
30
what is the posterior target area
retromolar triangle
31
what is the medial border of the retromolar triangle
pterygomandibular raphe
32
what is the lateral border of the retromolar triangle
anterior border of the ramus of the mandible
33
what is the superior border of the retromolar triangle
hamular notch
34
what is the posterior target area characterized by
a dimple / depression found roughly in the center of the triangle
35
what are the 3 parameters to consider with a conventional mandibular block
1 - height = 6 - 10 mm above occlusal plane
2 - 3/4 of A-P distance from the CORONOID NOTCH back to the deepest part of the PTERYGOMANDIBULAR RAPHE
3 - bone contact = 2/3 - 3/4 of needle length
36
what needle is used in the conventional mandibular block
25 long
37
how much of the needle is inserted in the conventional mandibular block
2/3 - 3/4 of needle length until BONE CONTACT
38
T/F positive aspiration is common in the conventional mandibular block
true - 10-15%
39
in a conventional mandibular block, after reaching the target, slowly deposit the entire carpule except for ___
0.2 cc
40
what is the specific technique of the conventional mandibular block
align the barrel of the syringe with the contralateral premolars - parallel with the occlusal plane
41
in the conventional mandibular block the posterior target zone is forgiving regarding the precision of the needle placement as long as ___
depth is reached
42
the posterior target zone of the conventional mandibular block lies along the line that is defined by ___ and ___
- deepest extent of the mesial concavity of the ascending ramus
- deepest extent of the posterior concavity of the ramus
43
the extension of the line of the posterior target zone of the conventional mandibular block is
parallel to the occlusal plane defined by the mandibular teeth
44
what varies from patient to patient and can present as a barrier to the direct approach of reaching the target zone of the conventional mandibular block
lingula
45
how do you adjust your treatment of a patient with a prominent lingula presenting as a barrier to reaching the target zone of the conventional mandibular block
- penetrate the dimple
- swing the barrel of the syringe toward the midline in order to reach the posterior target area
46
while giving the conventional mandibular block, you encounter what you think is a prominent lingula, preventing you from reaching the target site. What do you do?
a - give up and go home
b - swing the barrel of the syringe from the contralateral premolar area (where you began with your conventional block) in towards the midline, thus redirecting your needle to a more medial position allowing you to get around the lingula
c - swing the barrel of the syringe from the contralateral premolar are (where you began with your conventional block) out towards the contralateral molar, thus redirecting your needle to a more medial position allowing you to get around the lingula
b - swing the barrel of the syringe from the contralateral premolar area (where you began with your conventional block) in towards the midline, thus redirecting your needle to a more medial position allowing you to get around the lingula
47
what is the anterior target are of the long buccal nerve block
anterior border of the ramus
48
where is penetration of the mucosa made in the long buccal nerve block
- distal & buccal to the most distal molar tooth in the arch
- needle parallel to the occlusal plane but buccal to the teeth
- reposition if necessary to 45 degree angle laterally
49
what needle is used for a long buccal nerve block
25 long
50
how much of the needle is inserted in a long buccal nerve block
until bone is contacted --> 1-4 mm
51
how much anesthetic is deposited with a long buccal nerve block
0.2 cc
52
what must you make sure of with al ong buccal nerve block
that the bevel is buried
repositioning is often required
53
how does the target zone of the Gow-Gates mandibular block differ from the conventional block
significantly SUPERIOR
54
does the Gow-Gates mandibular block have a shorter or longer onset of anesthesia
longer --> 5 - 10 minutes
55
Gow-Gates mandibular block is successful with ___ / ___
- bifid IAN
- bifid mandibular canals
56
where is the target area of the Gow-Gates mandibular block
anteromedial side of the condylar neck
57
where is penetration of the mucosa in the Gow-Gates mandibular block
needle placed distal to the max 2nd molar at height of tip of ML cusp (3rd molar if present)
58
in the Gow-Gates mandibular block, the syringe barrel is aligned with the imaginary line between ___ & ___
- intertragus notch (injection side)
- corner of the mouth (opposite side)
59
after giving the Gow-Gates mandibular block what must be occur
pt sits upright for 5 min w/ mouth open for 1-2 min
60
what needles is used in the Gow-Gates mandibular block
25 long
61
how much of the needle is inserted in the Gow-Gates mandibular block
3/4 needle length --> bone contact
62
what do you do to adjust if bone is not originally contacted in the Gow-Gates mandibular block
retract slightly and redirect needle anteriorly and syringe barrel posteriorly
63
___ of needle in the Gow-Gates mandibular block is usual cause of missing bone
medial deflection
64
T/F in the Gow-Gates mandibular block the needle bevel is critical in the success rate
false - NOT critical
65
how much of a carpule is injected in the Gow-Gates mandibular block
full carpule
66
the uni-linear mandibular block target zone is approximately ___ to the target for the conventional mandibular block
1 cm superior
67
the target zone of the uni-linear mandibular block is an area where what nerves are closest together
- IAN
- lingual nerve
- long buccal nerve
they run parallel in close proximity in a straight line
68
where does penetration of the mucosa occur in the uni-linear mandibular block
- 5 mm above the dimple of the posterior triangle
69
how much of the needle is inserted in the uni-linear mandibular block
1/2 - 2/3 needle length --> bone contact
70
what is the specific technique of the uni-linear mandibular block
- swing barrel to opposite side (C/P area)
- advance until bone is contacted
- withdraw 2 mm & deposit 3/4 carpule
- slowly withdraw, depositing remaining carpule
71
what is the target area of the Vazirani-Akinosi block
medial border of the ramus
72
what must you beware of with the Vazirani-Akinosi block
lateral flare of the ramus
73
what is the specific technique for the Vazirani-Akinosi block
- mouth closed, light occlusion
- syringe barrel = parallel to max occlusal plane
- needle inserted at mucogingival junction of max 2nd molar (3rd molar if present) & advanced in slightly lateral direction
74
T/F bone is NOT contacted in the Vazirani-Akinosi block
true
75
what needle is used for the Vazirani-Akinosi block
25 long
76
how much of the needle is inserted in the Vazirani-Akinosi block
3/4 neddle length from max tuberosity
77
what is the specific techniwue of the Vazirani-Akinosi block
bevel is AWAY from the mandibular ramus
CRITICAL!!
78
how much of a carpule is used in the Vazirani-Akinosi block
full carpule (1.8 cc)
79
how is the patient positioned in the Vazirani-Akinosi block
upright
80
which of the following has the most superior target area in the retromolar triangle in the posterior zone?
a - Vazirani-Akinosi mandibular block
b - Conventional mandibular block
c - Gow-Gates mandibular block
c - Gow-Gates mandibular blcok
81
what is the target area of the mental nerve block
- mental foramen
- between apices of 1st & 2nd premolars
82
where is penetration of the mucosa made in the mental nerve block
- depth of the vestibule
- anterior or posterior to neurovascular bundle (palpate)
83
what needles is used in the mental nerve block
25 long or 27 short
84
how much of the needle is inserted in the mental nerve block
deep enough to bury the bevel (3-5 mm)
85
how much of a carpule is used in the mental nerve block
1/2 carpule (1.0 cc)
86
what is a specific technique of the mental nerve block
apply pressure on the area that has "ballooned"
87
what does the mylohyoid nerve provide sensory innervation to
mandibular molars
88
what is the indication for a mylohyoid nerve block
successful mandibular block has been given BUT patient still has some sensation in some mandibular teeth (particularly molars)
89
what is the target area of the mylohyoid nerve block
- lingual approach
- just medial to mandibular 2nd molar
90
where does penetration of the mucosa occur in the mylohyoid nerve block
- depth of lingual vestibule
- 45 degree angle to long axis of the mandibular 2nd molar
91
what needle is used for the mylohyoid nerve block
25 long or 27 short
92
how much of the needle is inserted in the mylohyoid nerve block
1/4 - 1/3 needle length --> bone contact
93
how much of the carpule is injected in the mylohyoid nerve block
1/2 carpule (1.0 cc)
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