RU2296590C1 - Method for anesthetization during surgical interferences in area of innervation of the upper posterior alveolar nerves - Google Patents

Abstract

FIELD: medicine, stomatology.

SUBSTANCE: the present innovation deals with the techniques of local anesthesia and could be applied at fulfilling conduction anesthesia of the upper posterior alveolar nerves at different surgical interferences in area of their innervation. Due to palpation one should detect the top of the upper angle of zygomatic bone to puncture the needle into this point and move it in frontal plane from the top downwards and from outside inwards at the angle of 45° against sagittal plane up to the maxillary tuber. Then it is important to inject an anesthetic. The innovation enables to achieve valuable anesthesia of posterior maxillary departments not only for manipulations in dental area, bur for surgical manipulations in area of soft maxillary tissues and, also, provide the safety of the present innovation due to moving the needle in poorly vascularized area and far from large vessels.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, namely to dentistry, can be used for anesthesia by blocking the posterior upper alveolar nerves during various surgical interventions in the area of innervation of these nerves.

The main type of anesthesia in dentistry is different types of local anesthesia, which are shown in most cases when performing interventions in the maxillofacial region, accompanied by a pain reaction. On an outpatient basis, from 50 to 80% of surgical dental operations are performed under local anesthesia and only 1% shows general anesthesia.

Thus, a blockade in the innervation zone of the posterior upper alveolar nerves extending from the maxillary nerve in the region of the maxillary tubercle is performed to anesthetize the posterior parts of the upper jaw and alveolar process in the region of the upper large molars

A known method of pain relief during surgical interventions in the innervation zone of the upper posterior alveolar nerves (see Pashchuk A.Yu. Regional anesthesia. - M .: Medicine, - 1987, - 156 S.), in which anesthetic is administered using a needle, through the point of the apex of the angle formed by the lower edge of the zygomatic bone and the zygomatic alveolar ridge to the posterior surface of the ridge, where 1-1.5 ml of anesthetic solution is injected. After that, the needle is advanced into the tissues a little up, then inward, and then posteriorly at 2-2.5 cm, each time introducing an anesthetic solution. As an anesthetic, a 1-2% solution of xicain or trimecain in an amount of 3.5-5 ml can be used.

There is a method of pain relief during surgical interventions in the innervation zone of the upper posterior alveolar nerves (see Vaysblat S.N. Local anesthesia during operations on the face, jaws and teeth. - Kiev: State Medical Publishing House of the Ukrainian SSR, - 1962, - 469 p.), Which consists in the management of the anesthetic by holding the needle as follows: with the thumb of the left hand, the front surface of the zygomatic alveolar ridge is fixed, and the index finger is placed on its back surface, soft tissue is pushed a little down and pressed them behind the zygomatic eolar ridge to the upper jaw. The needle is injected between the indicated fingers under the lower edge of the zygomatic bone and, having injected an anesthetic solution, the needle is advanced to the posterior surface of the zygomatic alveolar ridge. Then the needle is carried out obliquely upward, inward and backward by 2-2.5 cm. For the introduction of the anesthetic solution on the right side, the front surface of the zygomatic alveolar ridge is fixed with the index finger of the left hand, and the thumb is placed at the angle formed by the lower edge of the zygomatic bone and the zygomatic alveolar ridge. The injection of the needle and its advancement in the soft tissues is carried out in the same way as on the left side.

A known method of analgesia during surgical interventions in the innervation zone of the upper posterior alveolar nerves (Braun H. Die ortliche Betaubung, ihre wissenschaftlichen Grundlagen und praktische Anwendung. - Leipzig. - 1921) by blocking the maxillary nerve in the pterygo-palatine palatine 1 ) In this case, the needle is injected at the apex of the lower angle of the zygomatic bone and the needle is moved inward under the zygomatic bone and up until it reaches the maxillary tubercle. Gliding in close proximity to the bone, the needle penetrates the pterygopalatine fossa. At a depth of 5-6 cm, the needle reaches a round hole, after which 5 ml of anesthetic solution is injected).

The above extraoral oral papillary anesthesia methods during surgical interventions in the area of innervation of the upper alveolar nerves share common similar technical features of their implementation. With these methods of anesthesia, the needle is inserted before contact with the tubercle of the upper jaw and further along its surface. An inserted needle with respect to the convex surface of the tuber of the upper jaw is at an acute angle to it. With blockade of the posterior upper alveolar nerves, errors and complications often occur. These include: the formation of a hematoma behind the tubercle of the upper jaw, damage to the pterygoid venous plexus, the development of a post-injection abscess or phlegmon due to suppuration of the hematoma, the development of temporary blindness and strabismus with a deep immersion of the needle, ischemic tissue necrosis, etc. When studying the comparative characteristics of the effectiveness and safety of local anesthesia methods in the upper jaw, some authors (Rabinovich S.A., Moskovets ON, Lukyanov M.V.What concerns dental practitioners first of all? Actual aspects of the safety of local anesthesia in dentistry. // New in dentistry. - 2002. - No. 4. - P.4-9) determined that complications of tuberous anesthesia are found in 10.3% of cases, with blockade of the maxillary nerve in the pterygo-palatine fossa by the sub-cheekbone pathway according to Brown - in 8% cases.

Closest to the claimed invention is a method of analgesia during surgical interventions in the innervation zone of the posterior upper alveolar nerves, in which the anesthetic is injected into the anterolateral face below the zygomatic bone (Egorov P.M. Local anesthesia in dentistry. - M .: Medicine, - 1985, - 160 p.). In this case, the individual depth of the location of the posterior upper alveolar nerves near the tubercle of the upper jaw is preliminarily determined; for this, the patient measures the distance from the top of the lower external corner of the eye socket to the top of the antero-lower angle of the zygomatic bone. The distance between these points is noted on the syringe needle. Then they inject a needle into the apex of the anteroposterior angle of the zygomatic bone and advance it through the soft tissues, under the zygomatic bone, for a specified distance in a straight line located at an angle of 90 ° to the Frankfurt horizontal and 45 ° to the median sagittal plane. The needle passes through the skin, subcutaneous tissue, fatty body of the cheek to the tubercle of the upper jaw (figure 2). Along the way of moving the needle and in the tuber of the upper jaw, 2-5 ml of anesthetic solution is injected. 5-10 minutes after administration of the anesthetic solution, anesthesia of the innervation zone of the posterior upper alveolar nerves occurs (Fig. 2).

Experimental studies showed that when performing the prototype method, the angle between the injected injection needle and the tubercle of the upper jaw ranges from 0 to 14 ° and when the needle is advanced along the bone, damage to blood vessels and nerves that are fixed to the periosteum, especially in the area of their entry into the bone tubules. Therefore, it is impossible to agree with the opinion of many authors who indicate that to prevent the formation of a hematoma, it is necessary to constantly inject an anesthetic solution as the needle moves in the tissues, and this jet of liquid discharges the blood vessels, as a result of which their injury and hematoma formation are eliminated.

In an experimental study of the prototype method, it was found that the needle introduced to a predetermined depth can be in contact with the body of the upper jaw in the region of the angle formed between it and the zygomatic process of this bone 0.6-1.0 cm below the lateral part of the inferiororbital fissure at an angle of 20- 30 ° to the tubercle of the upper jaw, and the end of the needle may be anterior to the posterior upper alveolar nerves by 0.7-0.9 cm. The puncture channel of the needle passes anteriorly and lower from the final section of the maxillary artery and anterior to the pterygoid venous plexus. It should be noted that the needle in this case is directly directed towards the lower orbital fissure and, with further advancement, it passes into the orbit through the lateral part of the lower orbital fissure or the injected anesthetic solution directly passes into the orbit, which is extremely dangerous.

The claimed invention solves the problem of creating a method that eliminates the complications associated with tissue damage in the orbit, as well as damage to blood vessels and the formation of hematomas.

From known information sources, the features that distinguish the claimed invention are unknown, therefore, we can conclude that the invention meets the criterion of "novelty" and the criterion of "inventive step".

The problem is solved in that when anesthetizing for surgical interventions in the innervation zone of the posterior upper alveolar nerves by introducing an anesthetic using a promoted needle into the anterolateral face, the needle is injected at the top of the upper corner of the zygomatic bone, and then it is advanced in the frontal plane from top to bottom and from the outside inward at an angle of 45 ° to the sagittal plane to the stop in the tubercle of the upper jaw.

The method is as follows. The upper angle of the zygomatic bone is palpated between its frontal and temporal processes and the skin of this area is treated with an alcoholic solution of iodine, alcohol and intracutaneous anesthesia with a thin needle. Then a needle is injected in the upper corner of the zygomatic bone and it is advanced in the frontal plane from top to bottom and from the outside inward at an angle of 45 ° to the sagittal plane until it stops in the tubercle of the upper jaw. The depth of insertion of the needle varies from 3.2 to 4.0 cm. The needle passes through the skin, subcutaneous tissue, temporal fascia, fatty body of the cheek to the tubercle of the upper jaw. As the needle advances and in the area of the tubercle of the upper jaw, 3-5 ml of anesthetic solution is injected. Usually, 5 minutes after blockade, anesthesia of the innervation zone of the posterior upper alveolar nerves occurs (Fig. 3a is a front view, Fig. 3b is a side view).

In this case, the needle abuts against the tubercle of the upper jaw at an angle of 40-45 °. The point of contact between the needle and the bone is located in the middle of the height of the upper jaw body posterior to the angle formed between the tubercle of the upper jaw and the zygomatic process of the same bone, 0.6-1.0 cm below the lower orbital fissure by 1.5-1.8 cm , anterior to the pterygo-palatine fossa by 1.3-1.6 cm, anterior to the posterior superior alveolar nerves by 0.5-0.8 cm. The puncture channel of the needle passes anteriorly from the terminal branches of the maxillary artery by 1.0-1, 4 cm and anterior to the pterygoid venous plexus, therefore, the possibility of damage to blood vessels and the image is excluded hematoma.

When a needle is inserted through the upper angle of the zygomatic bone, it passes to the other side from the lower orbital fissure, and even with an experimental change in the direction of the puncture canal towards the lower orbital fissure, the needle does not pass there, therefore complications from the orbit are impossible.

Example 1. Patient Sh-ev VN, 30 years old (Medical record No. 6721), 07/21/05 was admitted to the Department of Oral and Maxillofacial Surgery of the Republican Clinical Hospital No. 1 of the Ministry of Health of the Chuvash Republic with a diagnosis of Acute odontogenic periostitis of the upper jaw left. After the examination, the patient was performed supra-zygomatic blockade of the posterior upper alveolar nerves on the left by our proposed method. 5 minutes after the blockade, there was complete anesthesia of the posterior parts of the upper jaw and the alveolar process in the region of the upper large molars. After this, the operation was performed: Tooth extraction 27. Opening of the subperiosteal abscess.

Example 2. Patient K-on N.Yu., 25 years old (Medical record No. 6763), 07/22/05 was admitted to the maxillofacial surgery department of the Republican Clinical Hospital No. 1 of the Ministry of Health of the Chuvash Republic with a diagnosis of Acute odontogenic osteomyelitis of the upper jaw left. Abscess of the temporal fossa on the left. Under local anesthesia by the superskul method of blockade of the posterior upper alveolar nerves, the operation was performed on July 22, 2005: Tooth extraction 28. Autopsy of the purulent focus.

After the blockade, there was complete anesthesia of the region of innervation of the posterior upper alveolar nerves, during the operation the patient did not notice pain.

Example 3. Patient S-ko L.A., 54 years old, came for outpatient treatment at the dental surgery room of the Municipal Clinical Hospital of the City Hospital of Cheboksary with a diagnosis of Exacerbation of chronic granulating periodontitis. Under local anesthesia according to the proposed supra-school method, an operation was performed: Removing 18 tooth with curettage of the hole. Anesthesia of the surgical area was complete.

Thus, examples of the use of the claimed method in the clinic of the supra-zygomatic blockade of the posterior upper alveolar nerves in the clinic show that when it is used, there is complete anesthesia of the posterior parts of the upper jaw and upper molars. Not only in the treatment of upper molars, but also during the opening of purulent processes of soft tissues and upper jaw at the level of molars, this method of blockade allows tissue incision to be performed painlessly.

The claimed method was tested in a clinic for 12 patients with a positive result.

When using this method of blockade, no complications of the execution technique are observed. The above needle injection and its advancement exclude the formation of a hematoma, since the needle passes in a weakly vascularized area and away from large vessels. Anatomical landmarks of the needle injection site are determined in patients in all age groups. The advantages of the method we recommend are the availability, simplicity and safety of the anesthesia technique.

Claims (1)

Method of anesthesia during surgical interventions in the area of innervation of the posterior superior alveolar nerves by introducing an anesthetic using a promoted needle into the anterolateral region of the face, characterized in that the needle is injected at the apex of the upper corner of the zygomatic bone, and then it is advanced in the frontal plane from top to bottom and inside at an angle of 45 ° to the sagittal plane to the stop in the tubercle of the upper jaw.

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