上海交大：《口腔疾病》英文版

Nerve block anesthesia in Dentisti Xudong Wang, DDS, MD Dept of Oral Maxillofac Surg Affiliated Ninth People's Hospital Shanghai Second Medical University 2021/221

2021/2/21 Nerve Block Anesthesia in Dentistry Dept. of Oral & Maxillofac Surg. Affiliated Ninth People’s Hospital Shanghai Second Medical University Xudong Wang, DDS,MD

Local anesthesia > Topical anesthesia(表面麻醉) > Local Infiltration(局部浸润麻醉) small area anesthetized (one or two teeth) solution deposited near terminal nerve endings ○ 2 extractions > Nerve block(阻滞麻醉) REVIEW deposited near large nerve trucks 2021/221

2021/2/21 Local Anesthesia REVIEW ➢ Topical Anesthesia(表面麻醉) ➢ Local Infiltration( 局部浸润麻醉) • small area anesthetized (one or two teeth) • solution deposited near terminal nerve endings • 8 8 , 2 2 extractions ➢ Nerve Block ( 阻滞麻醉) • deposited near large nerve trucks

Advantages of nerve block Larger analgesia area avoid several injections Less dosage long-lasting Away from the lesion --avoid spreading of infection tumor seeding Less tissue deformity post-injection-- plastic surgery Better Anesthetic Effectiveness 2021/221

2021/2/21 Advantages of nerve block ➢ Larger analgesia area & avoid several injections ➢ Less dosage & long--lasting ➢ Away from the lesion -- avoid spreading of infection & tumor seeding ➢ Less tissue deformity post-injection -- plastic surgery ➢ Better Anesthetic Effectiveness

Anatomy of Trigeminal Nerve 叉神经 Ophthalmic nerve Maxillary nerve Mandibular nerve 2021/221

2021/2/21 ➢ Ophthalmic Nerve ➢ Maxillary Nerve ➢ Mandibular Nerve Anatomy of Trigeminal Nerve (三叉神经)

Nerve block anesthesia Maxillary Nerve anesthesia Posterior superior alveolar block(上牙槽后神经) Buccal U Infraorbital block眶下神经) Palatal ∫ Greater palatine block(鹏大神经) Nasopalatine block(鼻腭神经) Less dense bone/ less anatomic variation Mandibular nerve anesthesia 2021/221

2021/2/21 ➢ Maxillary Nerve Anesthesia Posterior superior alveolar block（上牙槽后神经） Infraorbital block (眶下神经） Greater palatine block （腭大神经） Nasopalatine block（鼻腭神经） Less dense bone/ less anatomic variation ➢ Mandibular Nerve Anesthesia Nerve Block Anesthesia { { Buccal Palatal

Posterior Superior Alveolar Block PSA Block上牙槽后神经阻滞 Tuberosity Injection上颌结节注射法) > Spread of analgesia麻醉范围 876678 (mesiobuccal root Pulp alveolar process Buccal gingiva(牙龈) periodontium(牙周膜) periosteum(骨膜 麻醉区城 2021/221

2021/2/21 Posterior Superior Alveolar Block (PSA Block 上牙槽后神经阻滞, Tuberosity Injection上颌结节注射法) ➢ Spread of analgesia 麻醉范围 876 678 Pulp & alveolar process Buccal - gingiva(牙龈) - periodontium (牙周膜) - periosteum (骨膜) (mesiobuccal root)

Posterior Superior Alveolar block (PSA Block) Target area Injection site 77 distal apex Angulation Mucobuccal fold 2021/221

2021/2/21 Posterior Superior Alveolar Block (PSA Block) ➢ Injection site 7 7 distal apex Mucobuccal fold ➢ Angulation ➢ Target area

Posterior Superior Alveolar block (PSA Block) Depth ofpenetration Pterygoid plexus(翼丛 Average adult 16-20 mm Small adult and children 14mm Aptt(回抽 > Injection amount 1.5-2ml Hematoma(血肿) > Time to effect 5-10 min 2021/221

2021/2/21 Posterior Superior Alveolar Block (PSA Block) ➢ Depth of penetration Average adult 16-20 mm Small adult and children 14mm 1.5-2ml ➢ Injection amount Pterygoid plexus(翼丛) ➢ Time to effect 5-10 min ➢ Aspiration(回抽) Hematoma(血肿)

Posterior Superior Alveolar block 2021/221

2021/2/21 Posterior Superior Alveolar Block

Infraorbital block ( Io Block眶下神经阻滞) Indications 5—5 dental procedure Upper lip paranasal Minor Surgery Landmark of nfraorbitalforamen(眶下孔 5-10mm below the infraorbital rim 1-4mm medial to the pupil of the eye 2021/221

2021/2/21 Infraorbital Block (IO Block 眶下神经阻滞) ➢ Indications 5 5 dental procedure Upper lip & Paranasal Minor Surgery ➢ Landmark of Infraorbital foramen(眶下孔) 5-10mm below the infraorbital rim 1-4mm medial to the pupil of the eye