INFERIOR

INFERIOR ALVEOLAR
ALVEOLAR
NERVE
NERVE BLOCK
BLOCK
PRESENTED BY:

Malik Hina
BDS IIIrd yr.

INTRODUCTION

Inferior
alveolar
nerve

Inferior
Inferioralveolar
alveolar
nerve
nerveblock
blockisisaa
nerve
nerveblock
block
technique
techniquewhich
which
induces
anesthesia
induces anesthesia
in
inthe
theareas
areasof
of
mouth
mouth&&face
face
innervated
innervatedby
bythe
the
inferior
inferioralveolar
alveolar
nerve.
The
nerve.
Theinferior
inferior
alveolar
alveolarnerve
nerveisisaa
branch
branchof
ofthe
the
mandibular
mandibularnerve,
nerve,
the
thethird
thirddivision
divisionof
of
the
thetrigeminal
trigeminal
This
procedure
This
procedure
nerve.
nerve.
attempts
attemptsto
to
anesthetize
anesthetizethis
this
nerve
nerveprior
priorto
toits
its
entry
entryin
inthe
the
mandibular
mandibular
foramen
foramen

NERVES ANESTHETIZED

Incisive
nerve

AREAS ANESTHETIZED
1) Mandibular teeth
to the midline
2) Body of the mandible, inferior
portion of the ramus
3) Buccal mucoperiosteum,
mucous membrane anterior to
the mandibular first molar
(mental nerve)
4) Anterior two thirds of
the tongue & the
floor of the oral
cavity (lingual nerve)
5) Lingual soft tissues &
periosteum (lingual
nerve)

ANATOMICAL LANDMARKS
1)
Pterygomandibular
fold
2) Anterior border of
ramus of mandible
3) External
oblique ridge
4) Retromolar
Triangle
5) Internal
Oblique ridge
6) Coronoid
Notch
7) Pterygomandibular
raphae
8)
Pterygomand
ubular space
9) Buccal
sucking pad

Technique
Technique
Two techniques:
Direct technique
1)Inferior
1)Inferior
alveolar
alveolar
2)Lingual
2)Lingual
3)Long
3)Long
buccal
buccal

1) Long
1)buccal
Long
buccal
2) Lingual
Lingual
3)2)Inferior
3)alveolar
Inferior
alveolar

DIRECT TECHNIQUE
1ST POSITION:
IAN is
anaesthetized
from the opposite
side
2nd POSITION:
Lingual nerve
is
anaesthetized
from the same
side
3rd
POSITION:
Long buccal
nerve is
anaesthetiz
ed from the
same side

INDIRECT TECHNIQUE
1ST POSITION:
Long Buccal nv. is
anaesthetized
form the same
side
2nd
POSITION:
Lingual nerve
is
anaesthetize
d from the
same side
3rd
POSITION:
IAN is
anaesthetiz
ed from the
opposite
side

POSITION OF THE PATIENT

Position the patient
Position the patient
supine (recommended)
supine (recommended)
or semi supine.
or semi supine.
The mouth should be
The mouth should be
opened wide to permit
opened wide to permit
greater visibility of and
greater visibility of and
access to the injection
access to the injection
site.
site.
When semi supine the
When semi supine the
mandible of the patient
mandible of the patient
should be parallel to the
should be parallel to the
floor.
floor.

POSITION OF THE

ADMINISTRATOR:

For
Forright
rightIANB,
IANB,aa
right
righthanded
handed
administrator
administratorshould
should
sit
sitat
atthe
the88oclock
oclock
position
positionfacing
facingthe
the
patient.
patient.

For
Forleft
leftIANB,
IANB,aaright
right
handed
handed
administrator
administratorshould
should
sit
sitat
at10
10oclock
oclock
position
positionfacing
facingthe
the
same
direction
as
same direction as

TECHNIQUE
1)
1) The
The area
area of
of
greatest
greatest depth
depth
i.e.,
i.e., the
the coronoid
coronoid
notch
notch is
is
identified
identified
2)
2)Palpating
Palpatingfinger
finger
isismoved
movedacross
across
the
theretromolar
retromolar
traingle
traingle&&onto
ontothe
the
internal
internaloblique
oblique
ridge
ridge
3)
3)The
Thethumb
thumbisis
moved
movedtowards
towardsthe
the
buccal
buccalside
sidetaking
taking
with
withititthe
thebuccal
buccal
sucking
suckingpad
pad

4)The operator may

4)The
operator
may
place
the
index finger
place the index
extraorally
behindfinger
the
extraorally
behind
the
ramus of mandible. In
ramus
of mandible.
In
this
manner
the
this manner the
anteroposterior
width
ofanteroposterior
the ramus maywidth
be
of
the
ramus
may
be
assessed.
assessed.
5)Ask the patient to
5)Ask
the
patient
to
keep
the
mouth
wide
keep the mouth wide
open.
Aopen.
syringe with 25 gauge
A
syringe
with 25 gauge
needle
is inserted
needleto
is the
inserted
parallel
occlusal
parallel
to
the
occlusal
plane of the mandibular
plane
of the
teeth
from
themandibular
opposite
teeth
from
the
opposite
side of the mouth
at a
side
of
the
mouth
lavel bisecting the at a
lavel bisecting
the the
finger,
peneterating
finger,ofpeneterating
the
tissues
the
tissues of the
pterygotemporal
pterygotemporal
depression
& entering

6)The
6)Theneedle
needleisis
penetrated
penetratedinto
intothe
the
tissues
tissuesuntil
untilgently
gently
contacting
contactingbone
boneon
on
the
theinternal
internalsurface
surface
of
oframus
ramusof
of
mandible.
mandible.
7)The
7)Theneedle
needleisisthe
the
withdrawn
withdrawnabout
about
1mm,
1mm,after
after
negative
negativeaspiration,
aspiration,
11to
1.8ml
to 1.8mlsolution
solution
isisdeposited
depositedslowly
slowly
(1
(1
to
to2mins)
2mins)
8)
8)of
ofthe
theinserted
inserted
depth
depthisis
withdrawn
withdrawn,,the
the
remainder
remainderof
ofthe
the
solution
is
injected
solution is injected
to
toanesthetize
anesthetizethe
the
lingual
lingualnerve.
nerve.

TECHNIQUE FOR LEFT INFERIOR

ALVEOLAR NERVE BLOCK:
PATIENT POSITION: SAME
OPERATOR POSITION: TOWARDS RIGHT & SLIGHTLY
TOWARDS THE BACK OF THE PATIENT.ARM IS PLACED
AROUND PATIENTS HEAD.

COMPLICATIONS
1)
1) TRANSIENT
TRANSIENT FACIAL
FACIAL
PARALYSIS:
PARALYSIS:
Produced
Producedby
bydeposition
depositionof
of
local
localanesthetic
anestheticinto
intothe
the
body
of
the
parotid
gland.
body of the parotid gland.
SIGNS
SIGNS AND
AND SYMPTOMS:
SYMPTOMS:
INABILITY
INABILITYTO
TOCLOSE
CLOSETHE
THE
LOWER
LOWEREYELID
EYELID&&DROPPING
DROPPING
OF
OFTHE
THELIP
LIPON
ONTHE
THE
AFFECTED
SIDE
AFFECTED SIDE

3)HEMATOMA
3)HEMATOMA(RARE):
(RARE):
A)
A) Swelling
Swellingof
oftissues
tissueson
on
the
themedial
medialside
sideof
ofthe
the
mandibular
mandibularramus
ramus
after
afterdeposition
depositionof
ofthe
the
anesthetic.
anesthetic.
B)
B) MANAGEMENT:
MANAGEMENT:
Pressure
Pressure&&cold
cold(e.g.,
(e.g.,
ice)
ice)to
tothe
thearea
areafor
foraa
minimum
minimumof
of33to
to
5mins.
5mins.
4)
TRISMUS:
4) TRISMUS:
Muscle
Musclesoreness
sorenessor
or
limited
limitedmovements
movements
1)
1) Slight
Slightsoreness
sorenessisis
quite
quitecommon
commonafter
after
IANB
IANB
2)
2) More
Moresevere
severesoreness
soreness
rare
rare

Thank you