46TH
ANNUAL
CONGRESS
OF
THE
SAEVA
SKUKUZA
16-‐20
FEBRUARY
2014
101
the needle until the palatine bone is reached predisposes to infraorbital and or
palatine artery and periorbita penetration. A modification to this technique has been
described where the local anaesthetic is deposited more superficially. This involves
the advancement of the needle no further than 15- 20 mm and deposition of local
anaesthetic within the extraperiorbital fat body. The extraperiorbital fat body
insertion technique describes equal efficacy at blocking the maxillary nerve when
10ml or 20 ml of solution is used and is described as having lower risk when
compared to the palatine bone insertion technique.
Inferior alveolar nerve block
Indications:
For sensory desensitization of all mandible molar and incisor teeth, lip and other soft
tissue structures associated with the mandible.
Anatomy:
The inferior alveolar nerve is the continuation of the mandible branch of the
trigeminal nerve. The inferior alveolar nerve gives of the sublingual nerve before
entering the mandible at the mandibular foramen. The nerve travels through the
mandibular canal before it terminates as the mental nerve that exits at the mental
foramen located mid diastema.
Procedure:
The patient is to be restrained in suitable stocks and the site of needle insertion is
surgically prepared. The site of local anaesthetic deposition is caudal to the
mandibular foramen. An imaginary line is drawn along the occlusal surface of the
cheek teeth and extended caudal to the mandibular margin. Another imaginary line is
drawn caudal to the caudal margin of the bony orbit. The line is drawn in a
dorsoventral direction. The intersection of the two imaginary lines is the site of the
mandibular foramen.
The vertical technique for locating the inferior alveolar nerve requires the needle is
inserted medial to the mandible on the ventral aspect of the rami of the mandible
and advanced dorsally until the predetermined site is reached. The syringe is
aspirated and then local anaesthetic is deposited. The angular technique involves
placement of the needle medial to the mandible and at the site of intersection
between the horizontal and vertical rami. The needle is then advanced dorsomedially
to the predetermined site of the mandibular foramen.
101