Method of conduction mental anaesthesia

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to anesthesiology in dentistry and can be applied as anesthesiology manual if case if it is necessary to block mental nerve branches. For this purpose by palpation defined is supraorbital sulcus and infraorbital foramen, through which first imaginary straight line is drawn to border of lower jaw. At distance 12-13 mm higher than lower jaw body base second imaginary line is drawn. In place of intersection of said lines anesthetic is introduced with simultaneous extraoral finger pressing near place of injection. Then during 1 minute massage of injection place area is carried out by movement of finger along lower jaw body.

EFFECT: method allows to ensure adequate anesthesia of mental nerve branches with simultaneous reduction of dose of introduced anesthetic due to taking into account anatomical peculiarities of said nerves location.

1 ex

 

The invention relates to medicine, namely to anesthesiology in dentistry.

There is a method of local anesthesia, in which finger pressure on the chin area near the injection anesthetic is lidocaine; maintaining this pressure when performing the injection of local anesthetic solution. Under these conditions, the sense of increasing tissue at the injection significantly less, and the pressure may be either on the mucous - when placing your finger inside your mouth or on the skin at the location of the finger outside the oral cavity. After the injection and withdrawal of the needle from the tissue pressure retain for not less than 2 minutes to prevent leakage of the introduced solution from the hole. After another 3 minutes develops anesthesia tissues innervated by these nerves. According to the author (S.F.Malamed), when pressed with your finger, the solution will be distributed inside the channel through the chin vent, which will create a high concentration of anesthetic around not only the mental nerve, but also the cutting of the branches of the lower alveolar nerve. Thus, using the enhancements proposed S.F.Malamed, effective nerve blockade at the chin vents can be attained at considerable simplification techniques, reducing trauma anesthesia, is ysenia efficacy and safety. When mastering the techniques of anesthesia efficiency reaches 86-90% (Anesthesia in the dental clinic. Bizyaev A.F., Ivanov HE, the author A.V., Rabinovich S. - M., Dentistry XXI century, p.60). This method is chosen for the prototype. However, clinical use of this method in approximately 40% of cases there are complications such as intravascular injection of local anesthetic (allergic, cardio-vascular, pulmonary, renal reactions), hematoma, direct nerve damage at the expense of depth of the needle hole in the chin, because of the difficulty of defining the chin holes - vcol needle of the syringe. In this way it is possible to conduct a local anesthetic in the area of premolars.

Complications when using the prototype method arises from the fact that locating the chin holes based on outdated anatomical data of 1976 (Anesthesia in the dental clinic. Bizyaev A.F., Ivanov HE, the author A.V., Rabinovich S. - M., Dentistry XXI century, p.61). As shown by anatomical, radiological and magnetic resonance tomographic studies of dentistry Department of General practice and anesthesiology, FPDO University in collaboration with the Department of normal anatomy University, odnorodnoe hole may be shifted to the canine or be directly under the root of the first premolar, while the mandibular canal continues to canine or makes a bend, and you can split the chin vents, etc. For manifestations of local anesthetic drug action of great importance is the ability to bind to protein receptors in the membrane of nerve fibers and blood plasma, as well as solubility in fats, high levels of which corresponds to the high toxicity of the drug. The high rate of protein binding increases the activity and duration of action of the drug. However, not only the activity but also the toxicity of local anesthetics depend on jirorastvorimogo and protein binding. Reducing the dose of anesthetic leads to minimizing the risk of possible complications such as allergic, cardio-vascular, pulmonary, renal reactions, etc. among patients with both explicit and not diagnosed somatic pathology. Reducing the dose of anesthetic, possibly again due to the fact that consideration is the current anatomical data about the location of the chin holes and branches of the same nerve.

The objective of the invention is to reduce the number of complications, reducing the dose of anesthetic, expansion and refinement of the indications for performing this type of anesthesia.

The technical result consists in the definition of the AI precise anatomical landmarks chin holes, providing effective and safe anesthesia.

This is due to the fact that by palpation determine supraorbital sulcus and infraorbital hole through them spend an imaginary straight line passing through the body of the mandible. At a distance of 12-13 mm above the base of the body of the mandible holding a second imaginary line and the location of their intersection is injected anesthetic while simultaneously extraoral finger pressing the space of vcol, then within 1 minute exercise area massage vcol, moving the finger back and forth along the body of the lower jaw near the chin of the hole.

Locating supraorbital sulcus and infraorbital holes by palpation it is necessary to conduct through them an imaginary straight line through the body of the mandible. The second imaginary line at a distance of 12-13 mm above the base of the body of the mandible and finding their intersection point allows you to determine the location of the chin vents, near which is vcol. The exact definition of anatomical landmarks chin vents can reduce the dose of anesthetic compared with previously used and thus reduce the number of complications such as allergic, cardio-vascular, pulmonary, renal reactions, etc. among patie the tov, having both explicit and not diagnosed somatic pathology. Moving the finger back and forth along the body of the mandible provides deep penetration of the anesthetic, increasing the efficiency of anesthesia. Implementation massage area vcol within 1 minute is explained by the pharmacokinetics of anesthetics.

The method is as follows.

By palpation determine supraorbital sulcus (for example, by pressing with the index finger) and the infraorbital foramen (using the middle finger), through the body of the mandible conduct an imaginary straight line, and at a distance of 12-13 mm above the base of the body of the mandible holding a second imaginary line and the location of their intersection is injected anesthetic while simultaneously extraoral finger pressing near places vcol, then within 1 minute exercise area massage vcol, moving the finger back and forth along the body of the mandible.

The proposed method allows to achieve effective and safe anesthesia in the area of premolars, canines and incisors on the lower jaw, enough to hold the major dental interventions: treatment of caries and its complications, tooth extraction, preparation of teeth for prosthetic

Clinical example.

Patient, 64 years of age, and a/b No. 31020.

He complained of simapro the free night of pain in the tooth 43 in GLU No. 2 of the Ministry of economic development.

History: in 1994 observed in cardiologist about coronary heart disease. In 1996 he suffered a myocardial infarction. My normal blood pressure considers 130/80. From other organs and systems without pathology, complications associated with local anesthesia and sedation were not previously noted, allergic reactions does not suffer. HIV is not socially dangerous infections is not ill.

Objective: tooth previously cured about tooth decay; at the distal-contact surfaces of the tooth 43 is a deep carious cavity filled with remnants of food and softened dentine, sounding on the bottom of the cavity is sharply painful, there is a message from the pulp chamber, cold test positive.

Diagnosis: K necrosis of the pulp 43 tooth.

Treatment: wiring under the chin anesthesia, which was performed using our proposed method: the patient by palpation determined the location of the supraorbital ridges, leaving the index finger on this area, then also determined the location of the infraorbital foramen, noting it using the middle finger; through the found landmarks, supraorbital sulcus and the infraorbital foramen held an imaginary straight line, continuing it to the bottom of the body of the mandible, and at a distance of 12-13 mm above the base of the body of the mandible had the second imaging agemay line, and their point of intersection spent vcol needle carpool syringe (aspiration test negative), introduced a local anesthetic Ultracain DS (4% articaine 1:200000) in the amount of 0.4 ml With simultaneous extraoral finger pressing near places vcol, then within 1 minute was carried out by area massage vcol, moving the finger back and forth along the body of the mandible. 50 seconds after the injection of anesthesia has reached its maximum effect. After local anesthesia measured blood pressure, which was 131/80. Complications from cardio-vascular, pulmonary, and other systems and organs are not marked, hematoma at the injection site is not found, allergic reactions are not identified. Was the treatment of caries with the removal of old fillings, the preparation and formation of cavities. The bottom is covered dentine sealing liquid, superimposed insulating gasket Vitribond, sealing a light-cured composite Grandio. Grinding, polishing fillings.

The method of anesthesia branches of the mental nerve by injecting local anesthetic into the area of projection of the chin holes, characterized in that by palpation determine supraorbital sulcus and the infraorbital foramen, through which up to the edge of the lower jaw spend the first imaginary straight line, at a distance of 12-13 mm above the bases of the of the body of the mandible holding a second imaginary line in the intersection of these lines is administered a local anesthetic while simultaneously extraoral finger pressing near places vcol, then for 1 min to provide massage area vcol, moving the finger along the body of the mandible.



 

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