RU2310480C1 - Method for carrying out mandibular anesthesia - Google Patents

Abstract

FIELD: medicine, stomatology.

SUBSTANCE: the present innovation deals with applying the methods of local anesthesia and could be applied at anesthetization of mandibular teeth. Due to palpation one should detect the most deepened site in area of anterior edge of mandibular branch. Then with the help of a syringe supplied with a needle of semi-oval shape it is necessary to puncture oral mucosa just into area of mandibular lingual followed by introducing the anesthetic. The innovation enables to avoid the traumas of fascia and a tendon of temporal and pterygoid muscles due to excluding the contact with the bone and oval shape of the needle and, also, achieve adequate anesthetization from the first time.

EFFECT: higher efficiency.

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Description

This invention relates to medicine, in particular to dentistry, and can be used to anesthetize the teeth of the lower jaw.

Effective anesthesia at the dental appointment remains one of the urgent problems of outpatient dentistry, since most dental interventions are accompanied by pain of one degree or another.

Numerous methods are known for performing mandibular anesthesia, first described by Richard J. Hall (1884).

Later in 1911, Guido Fisher proposed a modified method of mandibular anesthesia: the index finger is fixed in the retro-molar fossa, the syringe is placed on the opposite side, the needle is injected at the mid-phalanx level of the finger. Next, the needle is advanced to a depth of about 6 mm, before contact with the bone, then the syringe is moved parallel to the molars, moved about 6 mm more to bypass the temporal scallop, a little anesthetic is released. Then the syringe is moved back to its original position and advanced 10-15 mm until it comes into contact with the bone [P.Yu. Stolyarenko, History of the creation of novocaine, p.32, 2006].

This type of anesthesia is by far the most commonly used worldwide and has not undergone significant changes, although there are dozens of modifications of mandibular anesthesia.

Despite the sufficient popularity among dentists, this technique has a number of significant drawbacks, such as a high risk of damage to the tendon of the temporal muscle, internal pterygoid muscle, lower alveolar neurovascular bundle, and the fact that with this anesthesia using a straight needle it is difficult to repeat the individual relief of the tongue region with the lower jaws in each case. These shortcomings can sometimes lead to serious complications, especially among inexperienced specialists.

Closest to the proposed method is a method of conducting mandibular anesthesia, according to which the place of injection of the syringe needle is determined by palpation: with the index finger, the post-molar fossa is felt and the position of the temporal scallop is determined. The needle injection site is located inward from the temporal crest 0.75-1 cm above the level of the chewing surfaces of the molars. The syringe is placed on premolars or molars on the opposite side. Advancing the needle gradually and reaching a depth of about 0.75 cm to the bone, 0.5 ml of anesthetic solution is injected to turn off the lingual nerve located in front of the lower alveolar nerve, and at a depth of about 2 cm near the bony groove, in which lies before the entrance to the mandibular opening lower alveolar nerve, the remaining amount of solution is injected [A.I. Evdokimov, G.A. Vasiliev, Surgical dentistry, pp. 39-41, 1964].

The disadvantages of this method of anesthesia is that due to incorrect determination of the needle injection site and insertion of the needle from the pterygo-maxillary fold (mix the latter with the temporal scallop of the lower jaw), a feeling of numbness in the soft tissues of the pharynx appears. In case of damage to the medial pterygoid muscle by a needle, damage to blood vessels, there is a restriction on the opening of the mouth (post-injection contracture), the elimination of which requires prolonged treatment, sometimes surgical intervention. The appearance of zones of ischemia of the skin due to the vasoconstrictor action of the solution that has fallen into the lumen of the vessel is also noted. Areas of ischemia occur, covering almost the entire half of the face, diplopia. Frequent complications are the occurrence of subsequent pain and a decrease in sensitivity in the branching area of the lower alveolar nerve, apparently as a result of damage to its needle. Sometimes paresis of the facial nerve is observed [A.I. Evdokimov, G.A. Vasiliev, Surgical dentistry, pp. 41-42, 1964].

The technical result of this invention is to reduce the morbidity and increase the effectiveness of analgesia.

The technical result is achieved by the fact that in the method of conducting mandibular anesthesia by palpation to determine the landmark of the injection site and injecting the anesthetic with a syringe into the region of the tongue of the lower jaw, a distinctive feature is that as the landmark of the injection site of the needle use the most in-depth place of the front edge of the lower jaw branch and the injection is carried out with a syringe with a semi-oval-shaped needle into the oral mucosa directly into the region of the tongue of the lower jaw.

The essence of this method lies in the fact that when injecting a syringe needle according to the proposed method, the oval of the face is taken into account from the front edge of the lower jaw branch to the groove, which is formed due to the thickening of the front edge of the lower jaw branch due to the temporal crest and narrowing in the region of the bone groove where lower alveolar nerve before entering the mandibular canal. Initially, the needle is given a semi-oval shape by bending it around the perimeter using a sterile cap that is on the needle. Currently, modern karpulny technology produces sufficiently durable needles, which can be given a curved position.

The syringe is placed on the same side where anesthesia is performed.

Palpation determines the most in-depth place of the anterior edge of the lower jaw branch below the coronoid process, where the index finger is fixed. The needle is inserted into the mucous membrane of the oral cavity into the projection area of the tongue of the lower jaw, so that the tip of the needle makes contact with the inner surface of the branches of the lower jaw in the region of the tongue.

The advantage of this method is that due to the curvature of the needle, injury to various tissues can be eliminated, the anesthetic solution is injected not into the muscle, but in the immediate vicinity of the lower alveolar nerve, from where the solution diffuses into the lower alveolar nerve. Using the proposed method, you can achieve a positive effect of pain relief the first time; due to the bending of the needle, the risk of piercing and injury to various tissues is significantly reduced, which avoids unnecessary worries of the doctor and the patient’s fear, additional attempts at anesthesia and additional costs.

Example.

Patient I., born in 1987, appealed for rehabilitation of the oral cavity. The patient does not have 48 teeth and a weakly expressed pterygo-maxillary fold, which are landmarks in the classical form of anesthesia. In the capsule syringe, Sol. Ubestezini 1.7 ml and fixed needle for conduction anesthesia 27G × 35 m / m. Using a sterile cap with a needle, the needle is shaped into a semi-oval. The most deepened place in the region of the anterior edge of the lower jaw branch was determined by palpation, 0.3-0.5 cm below the base of the coronoid process and fixed with the index finger. The syringe was placed on the right half of the jaw on the chewing surface of the molars. The needle was injected in the projection of the tongue of the lower jaw in the area of the phalanx of the index finger, into the fold between the pterygo-maxillary fold and the front edge of the lower jaw branch. With a semicircular motion of the hand, the needle was advanced into the region of the tongue and 1 ml of anesthetic solution was released. After 30 seconds, according to the patient, numbness was noted in the region of the right half of the tongue. Then, after 2 minutes, the appearance of goose bumps was noted in the chin area and after 5-6 minutes a persistent effect of anesthesia was observed in the innervation of the right lower alveolar and lingual nerve.

Thus, the proposed method eliminates contact with the bone in the retro-molar region, which avoids trauma to the fascia and tendon of the temporal muscle. The semi-oval shape of the syringe needle significantly reduces the risk of injury to the fascia and bundles of the internal pterygoid muscle. In this case, it is not necessary to open the mouth as much as possible, muscles and tissues are in a semi-relaxed position, which is of great importance when the needle passes through soft tissues (muscle bundles, vessels, tendons, ligaments, etc.). This method of anesthesia significantly increases the effectiveness of analgesia.

Claims (1)

A method for performing mandibular anesthesia by palpation of a landmark injection site and introducing an anesthetic using a syringe into the region of the lower jaw tongue, characterized in that the most deepened place of the anterior edge of the lower jaw branch is used as a landmark for the injection site and the injection is carried out with a syringe with a semi-oval shaped needle the mucous membrane of the oral cavity, directly into the region of the tongue of the lower jaw.