3. Upper retroalveolar nerve and mandibular nerve block anesthesia

(1) Upper retroalveolar nerve block anesthesia is also called the maxillary tubercle injection method. This method is applicable to Extraction of maxillary molars and corresponding operations on the buccal gingiva, mucosa, and maxillary tubercle.

1. Intraoral injection method

(1) The patient should sit in a sitting position with his head slightly tilted back and his mouth half-open. The occlusal surface of the maxillary teeth should be at 45° to the ground plane. The surgeon uses a mouth mirror to retract the cheeks backward and upward to fully expose the upper molar area.

(2) Generally, the vestibular groove of the distal buccal root of the maxillary second molar is used as the needle insertion point. For children whose maxillary second molar has not yet erupted, the distal buccal root of the first molar is used as the insertion point. The vestibular sulcus is used as the needle entry point; for patients with missing maxillary molars, the vestibular sulcus on the zygomatic alveolar ridge is used as the needle entry point.

(3) The injection needle is at a 45° angle to the long axis of the maxillary teeth, and is inserted upward, backward, and inward at the same time. When inserting the needle, the needle tip slides along the arc-shaped surface of the maxillary tubercle to a depth of about 2cm. , if no blood is withdrawn, 1.5-2ml of anesthetic solution can be injected.

Note: The needle tip should not be inserted too deeply to avoid puncturing the pterygoid venous plexus behind the maxillary tubercle and causing hematoma.

(4) Anesthesia area and effect: Except for the buccal mesial root of the first molar, the pulp, periodontal ligament, alveolar process of the molar on the same side and the periosteum and gingival mucosa of the buccal side. Note that the buccal mesial root of the first molar is innervated by the middle alveolar nerve. Therefore, when extracting the maxillary first molar, it is necessary to perform infiltration anesthesia at the transitional groove mucosal turning point at the corresponding part of the buccal mesial root of the first molar. It usually takes effect in 5-10 minutes. At this time, there should be no pain when stimulating the gingival tissue with a sharp instrument.

2. Using the extraoral method, use fingers to touch the zygomatic alveolar ridge on the cheek to indicate the intersection angle formed by the lower edge of the zygomatic bone and the zygomatic process of the maxilla. Use a 4-5cm long injection needle to penetrate the skin directly. The bone surface is then pushed upward, posteriorly and inwardly for about 2em, and 2-3ml of anesthetic can be injected without blood withdrawal.

(2) Mandibular nerve block anesthesia

And Called the foramen ovale injection method, this method is suitable for the diagnosis and radiofrequency treatment of facial pain, such as atypical facial pain, digeminal neuralgia, etc.

1. Injection signs and methods

(1) First use a 21-gauge injection needle to insert a sterilized rubber vertical edge needle, directly touch the outer plate, and connect the lower edge of the zygomatic arch and the mandibular notch The midpoint is the insertion point. >

(2) Fix the rubber format 1CM away from the skin, mark the depth, then withdraw the needle under the skin, tilt the injection needle backward, upward, and inward 15 degrees again, and advance to the marked depth. The tip of the needle reaches near the foramen ovum posterior to the upper wall of the infratemporal fossa.

(3) Draw blood and inject 3-4ML of anesthetic.

2. Anesthesia area and effect, ipsilateral mandibular teeth, tongue, floor of mouth, mandible and perimandibular tissue , the ascending jaw muscles and temporal skin are anesthetized. It takes 5 to 10 minutes to take effect. Numbness, swelling, and burning sensation appear on the lower lip, corners of the mouth, and tip of the tongue, indicating that the anesthesia is effective. Generally it can last about 2 hours.

[Thinking Questions]

1. Describe the intraoral injection method of upper retroalveolar nerve block anesthesia and its precautions.

2. Describe the injection signs and methods of mandibular nerve block anesthesia.