RU2712314C1 - Method of local anesthesia in children for lower jaw teeth pain anesthesia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to pediatric dentistry and surgical dentistry, and can be used for conductive anesthesia of the mandibular nerve for dental anesthesia on the lower jaw for treatment and operation of their removal in children. For this purpose, the syringe is placed parallel to the dental closure line in anticipation of the oral cavity with retraction of the cheek and angle of the mouth, the prick in the middle of the wing-jaw fold, when moving inward without changing direction, we slide along the inner surface of the lower jaw branch and release a small amount of anesthetic for hydropreparation of tissues with deposition of the main amount of solution at depth of 1.5–2.0 cm in the area of the mandibular opening for deactivation of the mandibular nerve and teeth of the corresponding half of the lower jaw, and the remainder is when the syringe is removed to eliminate sensitivity of the areas innervated by the lingual and buccal nerves. Method allows reducing the injuries of the conductive anesthesia and the probability of infecting the injection canal, eliminating the injuries of the mandibular artery and vein, mandibular, lingual and buccal nerves, using the method not blindly, but using the anatomical landmarks.

EFFECT: method is characterized by considerably shorter duration of manipulation, low risk of intravascular introduction of an anesthetic solution, reduced unpleasant sensations during administration of the preparation, higher efficacy of anesthesia in children.

1 cl, 3 dwg

Description

The invention relates to medicine, namely to pediatric dentistry and surgical dentistry, and can be used for conduction anesthesia of the mandibular nerve with anesthesia of the teeth in the lower jaw for treatment and surgery for their removal in children.

The closest to execution is a method of modified mandibular anesthesia in children who refuse to open their mouths, in which the needle is injected medially from the anterior margin of the mouth and leads it in the anteroposterior direction to the middle of the branch, while anesthesia is almost painless and the children begin gradually open the mouth and anesthesia is completed in the usual way with the needle moving along the inner surface of the lower jaw branch at an angle of 15-30 ° to a depth of half its width (1.5-2 cm ) with the deposition of anesthetic substance (V.K. Leontyev, L.P. Kiselnikova "Children's therapeutic dentistry. National Guide" GEOTAR-Media, 2010. - S. 165-166).

The disadvantages of the described method are the lack of clear anatomical landmarks when injecting and holding an injection needle, taking into account the age of the mandibular opening in children, the forced need to turn the syringe when held at an angle of 15-30 ° to complete anesthesia in the usual way, while the manipulation becomes more difficult with intense chewing muscles of children who refuse to open their mouths wide with a turn of the syringe, the risk of an injection needle fracture increases, with insufficient opening of the mouth - lowering the effectiveness of analgesia, the need for additional infiltration anesthesia, which increases the pain of the procedure, the high probability of damage to the neurovascular bundle and infectious and inflammatory complications.

The intraoral method of mandibular anesthesia is known with limited mouth opening due to injuries and cicatricial deformity, inflammatory contracture, in which an injection is made into the mucous membrane of the cheek at the level of the neck of the last upper molar near the tubercle of the upper jaw, while the syringe is located almost parallel to the lower jaw branch, and the needle is advanced to a depth of 2.5 cm with the deposition of most of the anesthetic for blockade of the sensory and motor branches of the mandibular nerve, and the remainder is deposited when removed and the needle is to turn off the buccal and lingual nerve (BF Kadochnikov "Collection of scientific papers 209th dental clinic Tauride Military District" -Simferopol, 1956. - with 63-66.).

The disadvantages of this method are the inability to accurately determine the injection site and the direction of the needle under vision control due to insufficient visibility in the upper part of the vestibule of the child’s oral cavity, insufficient analgesia due to the peculiarities of the anatomical location of the mandibular opening - it is lower, the risk of unintentional opening and closure of the dentition by a child with a displacement of the lower jaw during the execution of this method with a significant decrease in the effectiveness of anesthesia, and the same high probability of vessel injury and the development of postinjection hematoma, its suppuration.

The technical result of the invention is to increase the effectiveness of local anesthesia for anesthesia of the teeth in the lower jaw in children, in the presence of clear anatomical guidelines for implementing the method with a sufficient overview of the injection site and holding the injection needle to the site of deposition of the anesthetic, reducing the duration and manual simplicity of the method, in reducing intra-and post-injection complications associated with damage to the mandibular artery and vein, mandibular nerve, reducing the likelihood of development hematomas and sensitivity disorders of innervated areas, reducing the risk of infection of tissues in the area of the injection site, the minimum risk of breaking off the injection needle, due to the absence of the need to change its direction when performing the method.

The specified technical result is achieved in a method of local anesthesia in children for anesthesia of teeth in the lower jaw, including retraction of the cheek with the Minnesota or Farabeuf rotary expander in the area of the angle of the mouth with the patient’s teeth closed with a support in the projection of the lower jaw branch, we place the syringe parallel to the teeth closure line on the threshold of the oral cavity, we inject in the middle of the wing-maxillary fold, while moving deeper we slide along the branch of the lower jaw and carefully release a small amount of anesthetic for hydrotreating canals with slow deposition of the bulk of the solution at a depth of 1.5-2.0 cm in the projection of the mandibular foramen to turn off the eponymous nerve and teeth of the corresponding half of the lower jaw, and the remainder when the syringe is removed to eliminate the sensitivity of the areas innervated by the lingual and buccal nerves.

The anatomical reference point for accessing a work of injection is the line of closure of teeth in a child. The injection into the pterygo-maxillary fold sagittally at the level of the occlusal plane allows you to navigate the inner surface of the branches of the lower jaw and avoid injury to the mandibular artery and vein, mandibular nerve.

Accurate holding of the syringe needle with hydropreparation and its removal from the tissues after deposition of the anesthetic solution at a depth of 1.5-2.0 cm is enough to effectively turn off the mandibular, lingual and buccal nerves, and it also significantly reduces the duration of manipulation compared to the closest analogue.

Advance of the syringe without changing its trajectory parallel to the line of closure of the teeth avoids injury to the neurovascular bundle and reduces additional pain, which is much better tolerated by restless preschool children.

The method is illustrated in FIG. 1-3, where:

in FIG. 1 is a diagram of the retraction of the angle of the mouth and cheek of the child to the left with the Farabeuf 1 dilator and the injection point in the middle of the wing-jaw fold with closed teeth 2;

in FIG. 2 - arrangement of the syringe 3 parallel to the line of closure of the teeth and branches of the lower jaw 4;

in FIG. 3 is a diagram of the advancement of the syringe 3 without changing its path along the branch of the lower jaw 4 to the end point in the region of the opening of the lower jaw 5 to create the main depot of anesthetic.

The inventive method is performed, for example, as follows.

The operation to remove the lower first permanent or lower temporary molars, as well as fangs, is planned according to the results of objective methods of examining a child according to indications in the presence of clinical manifestations. After a preliminary conversation and psychological preparation, we ask the patient to sit in the dental chair in a prone position. At the first stage, we apply a dental gel for terminal anesthesia of the mucous membrane before injection from the side of the planned intervention with sliding movements along the lower arch of the vestibule of the mouth with transition to the wing-jaw fold, on which we gently tactilely without strong pressure determine the front border of the coronoid process of the lower jaw branch. We retract the cheeks with a hook "Farabeuf in the area of the corner of the mouth, ask the child to close his teeth. Using massaging movements we determine the borders of the lower jaw branch, we introduce the syringe in front of the mouth parallel to the closed teeth and inject the center of the wing-jaw fold. Hydrotreating the tissues, allowing a solution of 0.3 -0.4 ml we move the needle deep into parallel to the line of closure of the teeth and release the main amount of anesthetic 0.7-1.0 ml at a depth of 1.5-2.0 cm to turn off n.mandibularis and teeth of the corresponding half of the lower jaw, and the remainder of the solution up to 0.5 ml when the syringe is removed, we inject to complete the anesthesia of the areas of the innervated n.lingualis and n.buccalis. As a rule, the maximum effect occurs within no more than 8 minutes. We proceed to tooth extraction according to the generally accepted method with dissecting the circular ligament and its subsequent extraction. The child compresses the pressing bandage of the gauze swab with his teeth for 10-15 minutes for hemostasis.

The method is confirmed by the following clinical examples.

Example 1. Patient A., 5 years old, accompanied by her mother, was diagnosed with an exacerbation of chronic periodontitis of 84 teeth. Having received informed voluntary consent to the patient’s intervention in the mother’s hands, in the dental chair, the angle of the mouth was taken to the right with a straight spatula, placing it in front of the oral cavity with support on the lower jaw branch on the right. After applying the Lidoxor gel with the boy’s teeth closed, placing the syringe parallel to the closing line of the teeth through the vestibule of the oral cavity to the right, an injection was made in the center of the jaw fold, and 0.4 ml of Ubistesin 4% 1: 200000 solution was injected in-depth for hydrotreating the tissues. Further, at a depth of 1.5 cm, 1.0 ml of an anesthetic solution was deposited to turn off the mandibular nerve and teeth of the corresponding half of the lower jaw, and the remaining 0.3 ml when removing the syringe to turn off the lingual and buccal nerves. The child underwent conduction anesthesia calmly. After 8.5 minutes, the 84th tooth was removed by closing beak-like forceps. A gauze swab was placed locally between the teeth in the area of the compression well for 20 minutes for hemostasis. No intraoperative complications associated with local anesthesia were found during follow-up visits.

Example 2. Patient K., 8 years old, accompanied by her mother, was referred by a pediatric dentist with a diagnosis of Acute Pulpitis 36 Tooth to a dentist surgeon for local conduction anesthesia for tooth treatment. The retraction of the corner of the mouth on the left was carried out with the hook "Farabeuf", they asked the girl to close her jaws together. With a slight pressure of the retractor, the anterior border of the lower jaw branch was determined, the syringe was inserted in the vestibule of the left mouth at the level of the closed teeth line and an injection was made into the center of the wing-jaw fold. Assuming a solution of Ultracaine DS 1: 200000 in a volume of 0.3 ml, a needle was drawn deeper in parallel to the coronoid process without changing the path and the main amount of anesthetic 1.0 ml was released at a depth of 2.0 cm to turn off n.mandibularis and left teeth half of the jaw from the bottom, and the remaining part of the anesthetic drug 0.4 ml was injected when removing the syringe to complete the anesthesia of the areas innervated by n.lingualis and n.buccalis. After reaching the maximum effect of numbness of the skin and mucous membrane of typical areas, after 7 minutes, a pediatric dentist performed manipulations on the first visit to treatment of pulpitis of 36 teeth. In the second visit to the patient, no postinjection complications were noted, conduction anesthesia was not required.

Example 3. Patient I., 6 years old, accompanied by his parents, turned to the surgical department with a diagnosis of Acute pericoronitis in the region of 46 tooth. Filling in the surgical IDS, the Lidoxor gel was applied to the mucosa of the pterygo-maxillary fold. At the same time, the cheek and mouth angle to the right were retracted with a straight spatula, and the boy's teeth are closed. A syringe parallel to the closing line of the teeth through the vestibule of the oral cavity on the right made an injection in the middle of the wing-maxillary fold, previously assuming “Ultracain DS” 1: 200000 in the amount of 0.4 ml of solution, the needle was advanced to a depth of 1.7 cm. Deposited 1.0 ml of anesthetic solution to turn off the mandibular nerve, and the lingual and buccal nerves are turned off when 0.3 ml is released when the syringe is removed. After 8 minutes, an aperlectomy was performed painlessly. Hemostasis with a pressure bandage with gauze swabs, outwardly cold for 20 minutes in the cheek area.

The inventive method was applied in 114 cases in patients aged 4-11 years. In 25 cases, for the removal of temporary teeth, in 3 - permanent, 2 - for excision of the mucosal-periosteal hood with difficult eruption of permanent teeth, 84 - anesthesia for therapeutic dentistry. In all cases, an amide anesthetic of articaine series with an epinephrine of 1: 200000 in an amount of not more than 1 carpula was used for pain relief.

The inventive method can significantly reduce the morbidity of conduction anesthesia and the likelihood of infection of the injection channel, eliminate the risk of damage to the mandibular artery and vein, mandibular, lingual and buccal nerves, to implement the method not blindly, but using anatomical landmarks. The method is characterized by a significantly shorter duration of manipulation, a low risk of intravascular administration of an anesthetic solution, a decrease in discomfort during drug administration, and an increase in the effectiveness of anesthesia for treating and removing teeth in children.

Claims (1)

A method of local anesthesia for anesthesia of teeth in the lower jaw in children, including conductive anesthesia for treating or removing teeth of the corresponding side with the patient’s mouth closed, characterized in that for the implementation of the method with retraction of the angle of the mouth and cheek, the syringe is placed parallel to the junction line and the injection is performed the middle of the wing-maxillary fold, the needle is promoted without changing direction, sliding along the inner surface of the lower jaw branch with hydropreparation of the tissues 1.5-2.0 cm deeper and deposited about novnoe amount of anesthetic solution at mandibular holes mandibular nerve shutdown and teeth corresponding half of the lower jaw, and the residue - during injection syringe to eliminate sensitivity innervated by the buccal and lingual nerves regions.

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