RU2340363C2 - Method of blocking of conductivity of caudal alveolar nerve - Google Patents

Abstract

FIELD: medicine; stomatology.

SUBSTANCE: invention also can be used as the anesthesiology aid at treatment of various pathology of teeth and mandible, demanding blocking of conductivity of the caudal alveolar nerve. Administer an anaesthetic solution intraosseous into an area of retramolar fossa in a trabecular bone of ramus of mandible.

EFFECT: full penetration of anaesthetic into the mandibular channel and adequate anaesthesia of necessary area due to exact determination of the needle injection place.

Description

The invention relates to medicine, namely to dentistry, and can be used as a tool to turn off sensitivity in the treatment of various pathologies of the teeth and lower jaw.

When performing surgical interventions in the oral cavity, special attention is paid to obtaining adequate anesthesia of the tissues of the surgical field, which can be achieved by an infiltration or conduction anesthesia.

During operations on the lower jaw and the surrounding soft tissues, the conduction blockade of the lower hole of the nerve is most often performed.

A known method of blocking the conduction of the lower pit of the nerve at the mandibular foramen [Surgical dentistry / Ed. T.G. Robustova. - M.: Medicine, 2003. - S.80-82], which consists in the fact that when the patient’s mouth is wide open, after determining the anatomical landmarks of the injection site, the syringe is placed at the level of small molars or the first large molar of the opposite side. The needle is injected into the outer slope of the pterygo-mandibular fold in the middle of the distance between the chewing surfaces of the upper and lower large molars (in their absence, in the middle of the distance between the ridges of the alveolar processes). The needle is advanced outward and posteriorly to contact with the bone to a depth of 1.5-2.0 cm, after which 2.0-3.0 ml of anesthetic solution is injected, simultaneously turning off the conduction of the lower hole and lingual nerves. However, advancing the needle 2.0 cm, it is not always possible to achieve contact with the bone, which is explained by the anatomical features of the lower jaw branch. To eliminate this drawback, it is necessary to change the angle between the inner surface of the lower jaw branch and the needle, taking the syringe even further in the opposite direction. The decrease in the effectiveness of this anesthesia is often associated with the anatomical features of the lowermost hole of the nerve and not always clearly defined landmarks of the needle injection site.

There is a method of blocking the conduction of the lower hole of the nerve in the region of the mandibular roller [Surgical Dentistry / Ed. T.G. Robustova. - M .: Medicine, 2003. - P.74-76]. The technique of this anesthesia is similar to the above and differs in the place of needle injection and a more expanded area of pain relief.

When the conduction of the inferior cavernous nerve is turned off by both methods, complications can often be noted, the occurrence of which is associated with incorrect determination of the anatomical landmarks of the needle injection site. In this case, numbness of the pharyngeal tissue and damage to the internal pterygoid muscle may occur with the subsequent development of contracture of the lower jaw, the treatment of which sometimes requires a long time.

When the tip of the needle of the lower hole of the nerve is damaged, neuritis often develops, the clinical picture of which is characterized by prolonged pain and tissue hypesthesia in the area of nerve branching [Surgical Dentistry / Ed. T.G. Robustova. - M :, Medicine, 1996. - P.74].

Known use in dentistry of the intraosseous method of analgesia. In this case, deep anesthesia of the pulp and hard tissues of the tooth occurs. However, the anesthesia zone with this method of anesthesia is limited only to the area of one tooth [Kononenko Yu.G., Rozhko N.M., Ruzin G.P. Local anesthesia in outpatient dentistry. - M .: - 2004. - S.179-184].

The aim of the proposed method is to increase the efficiency of conduction anesthesia in the lower jaw by blocking the conductivity of the lower hole of the nerve and reducing the number of post-injection complications.

This goal is achieved by intraosseous administration of anesthetic in the region of the post-molar fossa.

The essence of the proposed method lies in the fact that the method of blocking the conductivity of the lower hole of the nerve, including trepanation of a compact plate in the area of the posterior molar fossa and the introduction of an anesthetic into the cancellous bone of the lower jaw, allows the complete shutdown of the conductivity of the lower hole in the mandible due to the penetration of the anesthetic into the mandibular canal this completely eliminate these complications.

The method is as follows.

To perform anesthesia, a device for intraosseous administration of drugs into the lower jaw is used [RF patent for utility model No. 544514, dated July 10, 2006; - Bull. No. 19. - 2006]. The anatomical landmark of the needle injection site is the post-molar fossa. The choice of injection site is justified by the following criteria: a - the post-molar fossa with a wide open mouth is well defined both visually and by palpation; b - in this zone, the ratio of compact and spongy substances is approximately the same, and the thickness of the inner compact plate adjacent to the posterior molar fossa is thinner than the outer [Busygin A.T. The structure of the jaw bones. - Tashkent, Medizd UzSSR, 1962. - P.32-33.]; c - this zone is located close to the initial third of the mandibular canal, in which the lower pit of the nerve passes [Fedotov S.N. Rehabilitation of patients with injuries of the mandibular nerve during fractures of the lower jaw, treated by the method of sparing osteosynthesis of fragments: Abstract. dis. ... Dr. honey. sciences. - M .: 1982. - S.13].

The nozzle with a needle is fixed in the tip of the drill. After anesthetization of the injection site with the traditional method of infiltration anesthesia, the needle is inserted into the spongy bone at an angle of 45 ° in the area of the posterior molar fossa. The entry of a needle into the cancellous bone is determined by its characteristic failure. The nozzle twists, a syringe is fixed in the needle cannula. By twisting the piston, a strictly metered amount of anesthetic is injected, after which the needle and syringe are easily removed. Through the system of feeding tubules of the bone, the anesthetic penetrates into the mandibular canal, blocking the conductivity of the lower ductal nerve. Anesthesia occurs in 1-2 minutes.

Thus, the proposed method for blocking the conductivity of the lower ductal nerve, including trepanation of the compact bone in the region of the posterior molar fossa and the introduction of an anesthetic of the lower jaw branch into the cancellous bone, makes it possible to completely switch off the conductivity of the lower duct nerve due to the penetration of the anesthetic into the mandibular canal and use only one anatomical landmark; to exclude such post-injection complications as a hematoma, neuritis of the lower hole of the nerve, contracture of the lower jaw.

Claims (1)

A method for blocking the conductivity of the lower testicular nerve, characterized in that the anesthetic solution is injected intraosseously in the region of the post-molar fossa into the cancellous bone of the lower jaw branch.