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| '''Inferior alveolar nerve block''' (abbreviated to '''IANB''', and also termed '''inferior alveolar nerve anesthesia''' or '''inferior dental block''') is a [[nerve block]] technique which induces anesthesia (numbness) in the areas of the mouth and face innervated by one of the [[inferior alveolar nerve]]s which are paired on the left and right side. These areas are the skin and mucous membranes of the lower lip, the skin of the chin, the lower teeth and the labial gingiva of the anterior teeth, all unilaterally to the midline of the side on which the block is administered.<ref>Agur, Anne M.R., and Arthur F. Dalley. Grant's Atlas Of Anatomy. 12th ed. Maryland, USA: Lippincott Williams & Wilkins, 2009. Print.</ref> However, depending on technique, the [[long buccal nerve]] may not be <ref>{{Cite journal|last=Aker|first=F. D.|date=2001|title=Blocking the buccal nerve using two methods of inferior alveolar block injection|journal=Clinical Anatomy (New York, N.Y.)|volume=14|issue=2|pages=111–119|doi=10.1002/1098-2353(200103)14:2<111::AID-CA1019>3.0.CO;2-3|issn=0897-3806|pmid=11241746}}</ref> anesthetized by an IANB and therefore an area of buccal gingiva adjacent to the lower posterior teeth will retain normal sensation unless that nerve is anesthetized separately, via a (long) [[Buccal nerve#Anesthesia|buccal nerve block]]. The inferior alveolar nerve is a branch of the [[mandibular nerve]], the third division of the [[trigeminal nerve]]. This procedure attempts to anaesthetise the inferior alveolar nerve prior to it entering the [[mandibular foramen]] on the medial surface of the mandibular ramus.
| | {{Short description|Anesthesia technique for the inferior alveolar nerve}} |
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| ==Symptoms of anesthesia== | | ==Inferior Alveolar Nerve Anesthesia== |
| Administration of anesthesia near the mandibular foramen causes blockage of the inferior alveolar nerve and the nearby lingual nerve by diffusion (includes supplying the [[tongue]]). This causes patients to lose sensation in:
| | The '''inferior alveolar nerve anesthesia''' is a common dental procedure used to achieve [[local anesthesia]] in the [[mandibular]] region. This technique is primarily employed to anesthetize the [[inferior alveolar nerve]], which supplies sensation to the lower teeth, the lower lip, and part of the chin. |
| * their mandibular teeth on one side (via inferior alveolar nerve block)
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| * their [[lower lip]] and chin on one side (via [[mental nerve]] block)
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| * and parts of their tongue and lingual gingival tissue on one side except on the cheek side of the mandibular molars (via [[lingual nerve]] block); a buccal block will anesthetize this later tissue area.
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| Another symptom is harmless numbness and tingling of the body of the tongue and floor of the mouth, which indicates that the lingual nerve, a branch of the mandibular nerve, is anesthetized. Another symptom that can occur is “lingual shock” as the needle passes by the lingual nerve during administration. The patient may make an involuntary movement, varying from a slight opening of the eyes to jumping in the chair. This symptom is only momentary, and anesthesia will quickly occur.<ref name=":0" />
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| ==Injection techniques== | | ==Anatomy== |
| There are a number of techniques that are commonly used to achieve inferior alveolar nerve anesthesia. The most commonly used techniques involve an attempted block of an entire portion of the inferior alveolar nerve:
| | The [[inferior alveolar nerve]] is a branch of the [[mandibular nerve]], which is itself a branch of the [[trigeminal nerve]] (cranial nerve V). The inferior alveolar nerve enters the [[mandibular foramen]] on the medial surface of the [[mandible]] and travels through the [[mandibular canal]], providing sensory innervation to the lower teeth. It exits the mandible through the [[mental foramen]] as the [[mental nerve]], supplying sensation to the lower lip and chin. |
| * Inferior alveolar nerve block or IANB - The nerve is approached from the opposite side of the mouth over the contralateral premolars. After piercing the mandibular tissue on the medial border of the mandibular ramus within the pterygomandibular space and then contacting medial surface of the alveolar bone as well as being lateral to the pterygomandibular fold and the sphenomandibular ligament, the injection is given.<ref name=":0" />
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| * Gow-Gates technique - Invented by [[Australia]]n dentist George A.E. Gow-Gates in the mid-1970s, the needle is directed at the neck of the condyle just under the insertion of the lateral pterygoid muscle.<ref>[http://www.doctorspiller.com/gow-gates_block.htm Gow-Gates technique, explained]</ref> This is used for more extensive anesthesia or when there is failure of the IANB
| | ==Indications== |
| * Vazirani-Akinosi technique - Invented by Sunder J. Vazirani in 1960 and later reintroduced in 1977 by Oyekunle J. Akinosi, a closed-mouth injection technique, the syringe is "advanced parallel to the maxillary occlusal plane at the level of the [[maxilla]]ry [[mucogingival junction]]."<ref>{{cite journal |author=Meechan JG |title=How to overcome failed local anaesthesia |journal=Br Dent J |volume=186 |issue=1 |pages=15–20 |date=January 1999 |pmid=10028738 |doi=10.1038/sj.bdj.4800006}}</ref> This is used when the patient cannot open his mouth enough for the IANB.
| | Inferior alveolar nerve anesthesia is indicated for dental procedures involving the lower teeth, such as [[tooth extraction]], [[filling]], and [[root canal therapy]]. It is also used for surgical procedures in the mandibular region. |
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| | ==Technique== |
| | The technique for administering inferior alveolar nerve anesthesia involves the following steps: |
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| | 1. '''Patient Positioning''': The patient is seated in a reclined position with the mouth open wide. |
| | 2. '''Landmark Identification''': The practitioner identifies the [[coronoid notch]], the [[pterygomandibular raphe]], and the occlusal plane of the lower teeth. |
| | 3. '''Needle Insertion''': A long dental needle is inserted into the mucosa on the medial side of the mandible, lateral to the pterygomandibular raphe, and advanced until bone is contacted near the mandibular foramen. |
| | 4. '''Aspiration''': The practitioner aspirates to ensure the needle is not in a blood vessel. |
| | 5. '''Anesthetic Injection''': A local anesthetic solution, such as [[lidocaine]], is slowly injected to block the nerve. |
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| ==Complications== | | ==Complications== |
| * The most common adverse effect of this injection is accidental self-inflicted trauma after the procedure, either by biting the lip or tongue or by thermal burn caused by inadvertent drinking of fluid that is too hot. This classically occurs in children or those with learning disability.<ref name=":1">Local Anesthesia for the Dental Hygienist, Logothetis, Elsevier, 2012</ref>
| | Potential complications of inferior alveolar nerve anesthesia include: |
| * A blood vessel may be punctured accidentally and a hematoma or "blood blister" may occur that will heal over time.<ref name=":1" />
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| * If needle is positioned too posteriorly, anesthetic may be put into [[parotid gland]], that may cause transient facial paralysis of the facial nerve or cranial Nerve VII (7). Symptoms of this temporary loss of the use of the muscles of facial expression include the inability to close the eyelid and the drooping of the labial commissure on the affected side for a few hours.<ref name=":0">Illustrated Anatomy of the Head and Neck, Fehrenbach and Herring, Elsevier, 2012, page 216</ref>
| | - '''Hematoma''': Caused by puncturing a blood vessel during injection. |
| * Also if the needle is placed too medially the medial pterygoid muscle can be injected, resulting in [[trismus]]. | | - '''Trismus''': Limited mouth opening due to muscle spasm. |
| * The sphenomandibular ligament may act as a barrier to the agent if the injection is given too shallow and the lingual nerve is only anesthetized.<ref name=":0" /> | | - '''Nerve Injury''': Rarely, the needle may cause temporary or permanent nerve damage. |
| * This injection can rarely cause [[needle tract infection]]s of the [[pterygomandibular space]].<ref name="Connor 1988">{{cite journal|last=Connor|first=JP|author2=Edelson, JG|title=Needle tract infection. A case report.|journal=Oral Surgery, Oral Medicine, and Oral Pathology|date=April 1988|volume=65|issue=4|pages=401–3|pmid=3163131|doi=10.1016/0030-4220(88)90351-9|url=https://zenodo.org/record/1258246}}</ref><ref name="Hupp 2008">{{cite book|vauthors=Hupp JR, Ellis E, Tucker MR |title=Contemporary oral and maxillofacial surgery|year=2008|publisher=Mosby Elsevier|location=St. Louis, Mo.|isbn=9780323049030|pages=317–333|edition=5th}}</ref> This is because the mouth contains many types of bacteria which are normally harmless by virtue of the physical barrier that the mucosa presents. However, if they are inoculated into the tissues during an injection, they can become [[pathogenic]] (disease causing).
| | - '''Inadequate Anesthesia''': Failure to achieve complete numbness, requiring additional injections. |
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| | ==Related Pages== |
| | * [[Local anesthesia]] |
| | * [[Mandibular nerve]] |
| | * [[Trigeminal nerve]] |
| | * [[Dental anesthesia]] |
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| == References ==
| | [[Category:Dental procedures]] |
| {{Reflist}}
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| {{stb}}
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| {{Anesthesia}}
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| [[Category:Anesthesia]] | | [[Category:Anesthesia]] |
| [[Category:Dentistry]]
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Anesthesia technique for the inferior alveolar nerve
Inferior Alveolar Nerve Anesthesia[edit]
The inferior alveolar nerve anesthesia is a common dental procedure used to achieve local anesthesia in the mandibular region. This technique is primarily employed to anesthetize the inferior alveolar nerve, which supplies sensation to the lower teeth, the lower lip, and part of the chin.
Anatomy[edit]
The inferior alveolar nerve is a branch of the mandibular nerve, which is itself a branch of the trigeminal nerve (cranial nerve V). The inferior alveolar nerve enters the mandibular foramen on the medial surface of the mandible and travels through the mandibular canal, providing sensory innervation to the lower teeth. It exits the mandible through the mental foramen as the mental nerve, supplying sensation to the lower lip and chin.
Indications[edit]
Inferior alveolar nerve anesthesia is indicated for dental procedures involving the lower teeth, such as tooth extraction, filling, and root canal therapy. It is also used for surgical procedures in the mandibular region.
Technique[edit]
The technique for administering inferior alveolar nerve anesthesia involves the following steps:
1. Patient Positioning: The patient is seated in a reclined position with the mouth open wide.
2. Landmark Identification: The practitioner identifies the coronoid notch, the pterygomandibular raphe, and the occlusal plane of the lower teeth.
3. Needle Insertion: A long dental needle is inserted into the mucosa on the medial side of the mandible, lateral to the pterygomandibular raphe, and advanced until bone is contacted near the mandibular foramen.
4. Aspiration: The practitioner aspirates to ensure the needle is not in a blood vessel.
5. Anesthetic Injection: A local anesthetic solution, such as lidocaine, is slowly injected to block the nerve.
Complications[edit]
Potential complications of inferior alveolar nerve anesthesia include:
- Hematoma: Caused by puncturing a blood vessel during injection.
- Trismus: Limited mouth opening due to muscle spasm.
- Nerve Injury: Rarely, the needle may cause temporary or permanent nerve damage.
- Inadequate Anesthesia: Failure to achieve complete numbness, requiring additional injections.
Related Pages[edit]
