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PROFESSOR:AMR ALY EL-SWIFYPROFESSOR&CHAIRMAN OF ORAL &MAXILLOFACIAL SURGERY DEPARTMENTFACULTY OF DENTISTRYSUEZ CANAL UNIVERSTITYname: maram emad eldien ahmed azaraa ID:1102210GROUP: BLocal anesthetia technique in oral and maxillofacial surgeryoverviewWhat are local anaethesiaAdvantage of local over general anestesiaIndications of local anesthesiacontraIndications of local anesthesiaLocal anethetic armanteriumAnatomical considerations of trigminal nerveTechniques of local anethesiaComplications of local anaethesia

What are local anestheticsLoss of sensation to pain in a specific area of the body without loss of consiousness

Advantage of local over general anestesiaSafetyEase of administrationLess costCo.operation of patientUnlimited oepration timeReduced bleeding during surgeryPatient is unfitfor general anaesthiaIndications of local anesthesiaTo detect the source of an orofacial paindiagnosticTo whom it may concern:Reduce or abolish the pain of a pathological condition e.g topical treatment of oral ulceration,for debilitating painful conditions such as trigiminal neuralgiatheraputicTo achieve comfort during operative procedureperioperativeTo reduce postoperative painpostoperativeDuring surgeryLocal hemostasisContraindications for dental anesthsiaRelative contraindicatioAbsolute contraindication1)Auriculo ventricular (AV block )1)Refused sonsent for local anethesia by patient2)Severe cardiac conduction defects2)Injection in an inflamed area3)Pregnancy3)Proven allergic predisposition to preparation4)Severe mental retardation4)Clotting defects(with nerve block)5)Cardiac decompensationAnatomical considerationsThe only nerve which the dental surgeon is concerned when administering alocal analgesics is the trigiminal nerveThe trigiminal nerve or the fifth cranial nerve is not only the most important nerve of middle cranial fossa ,but also the largest of all cranial nerves except the optic

Trigiminal nerve contains both sensory fand motor fibersAfferent fibers constitute the large sensory rootThe efferent fibers form the smaller motor rootGeneral somatic afferen fibers convey both exteroceptive and proprioceptive impulsesIn passing from neck to head the somatic sensory functions of the cervical nerves are taken over by trigiminal nerve

motor fibersSensory fibersMuscles of masticationsAnterior belly of digastricTensor palati muscleTensor tempaniMylohyoid muscleskin of the scalpFace(except skin over angel of the mandible)TeethOral and nasal cavities

:Trigiminal nerve divisions

Distribution and functionsCranial exitNerve divisionSensation from cornea,skin of forehead,scalp,eyelids,nose,and mucosa of nasal cavity and paranasal sinusesSuperios orbital fissureOphtlamic divisionSensation from skin of face over maxilla icluding upper lip,maxillary teeth,mucosa of nose,maxillary sinuses,and palateForamen rotunadumMaxillary divisionSensation from skin over mandible,includiong lower lip and side of head,mandibular teeth.tmepromandinular joint and mucosa of mouth and anterior two thirds of tongueMotor to muscle of mastications,mylohyoid,anterior belly of digastric.tensor paalti and tensor tempaniForamen ovaleMandibular division

Maxillary division of the trigiminal nerveType:purely sensoryOrigin:trigiminal nerveSize :smaller than mandibularIntracranial course: start in middle cranial fossa run in lateral wall of cavernus sinus above ophtalmic nerve Leave skull via foramen rotundum of greater wing of sphenoidBranches of maxillary nerveMaxillary within craniumBranches within ptergopalatine fossaBranches within the infraorbital canalBranches on the face

Branches within th cranium:Middle meningeal nerve to supply dura of middle cranial fossa

Branches within the ptergopalatine fossa zygomatic nerve ptergopalatine nerves posterior superior alveolar nerve

: Zygomatic nerve:Pass to orbit via inferior orbital fissure the give two branches 1)zygomatofacial nerve:to skin over zygomatic 2)zygomaticotemporal nerve: unite with lacrimal nerve and carry parasympathestic fibers to lacrimal gland the pass via its foramen to supply non hairy part of temporal region

Pterygopalatine nerves:two in number, descend to thepterygopalatine ganglion.[1]Although it is closely related to the pterygopalatine ganglion, it is still considered a branch of themaxillary nerveand does not synapse in the ganglion.It serve as communication for pterygopalatine ganglion and maxillary nerve

A.Orbital branchesB.Palatine branches: 1)grater(anterior)palatine nerve 2)lesser(middle and posterior)palatine nerve C.pharyngeal branchesD.Sphenopalatine 1)long spehnopalatine 2)shorte sphenopalatine

A.Nasal branches (nasopalatine nerve)

1)grater(anterior)palatine nerveIt descends through thegreater palatine canal, emerges upon thehard palatethrough thegreater palatine foramenSupply palatal mucoperiosteum of maxillary premolar and mollars

2)lesser(middle and posterior)palatine nerve descends through thegreater palatine canal, and emerges by thelesser palatine foramen. It supplies thesoft palate,tonsil, anduvula.

C.pharyngeal branches

It passes through thepalatovaginal canalwith the pharyngeal branch of themaxillary artery, and is distributed to themucous membraneof thenasal part of the pharynx, behind theauditory tube.

Short sphenopalatine

Orbital branch

Posterior superior alveolar nerve:Via pterygopalatine fissure before entrance of infraorbital groove to supply pulp,investing structures and buccul mucoperiosteum of upper 1st, 2nd ,3rd molars ,and supply mucosa of maxillary sinusBranches within infraorbital canalMiddle superior alveolar nerve: innervate pulp,investing structure and buccal mucuperiosteum of upper premolars .(it may be absent).anterior superior alveolar nerve :6 to 10 mm before the infraorbital nerve exit from infraorbital foramen it give anterior supperior alveolar nerve and it descend within the anterior wall of the maxillary sinusit innervate pupl,investing structure and buccal mucuperiostuen of upper anterior teeth

Branches on the face :thr infraorbital nerve escapte from the front of maxilla through the infraorbital foramen to give :Inferior palpebral : lower eyelid and associated conjuctivaExternal nasal :side of noseSuperior labialis: skin and mucous membrane of upper lip, labial gingiva, vestibule of the nose

Mandibular division

Mandibular divisionType:mixedSize: largest branch of trigiminal nerveIntracranial course:start in middle cranial fossa then leave skull through foramen oval of greater wing of sphenoid Extracranial: enter infratemporal fossabranchesBranches of the undivided nerve(mandibular trunk)Branches of the anterior divisionBranches of the psoterior division

Branches of undivides nerveNervous spinosus :via foramen spinosum to suppky dura of middle cranial fossaNerve to medial pterygoid :supply medial ptergyoid muscle ,tensor tempani.tensor palati

Branches of anterior division:DIVIDE INTO MOTOR BRANCH AND A SENSORY BRANCHBuccal nerve: the only sensory branch .innervate skin and mucosa of cheek,buccal mucoperiosteum of maxillary secnd premolar and morlars2 deep temporal nerve:innervate temporalis muscleMassetric nerve:innervate masseter muscleNerve to lateral pterygoid:innervate lateral pterygoid musclePosterior division:the large posterior trunk of the mandibular nerve is for the most part sensory but receive a few filaments from the motor rootIt passes downwards medial to the lateral pterygoid where it gives off three branches lingual inferior alveolar nerve auriculotemporalAuriculotemporal nerveThis nerve is of dental significance because it innervates the largest of salivary gland It arisses by two roots which embrace the middle meningeal artery and the unite

Communications of the auriculotemporal nerve1) two roots of the nerve-each root receive communicating fibers from otic ganglion.these fibers are post-ganglionic,parasympathetic secretory fibers that have come from glossopharyngeal nerve by way of lesser supperficial petrosal nerve.they control secretion of the parotid gland2)communicating branches of postganglionic sympathetic fibers.these vasomotor fibers pass to the parotid gland through the auriculotemporal nervecommunicating branches to the facial nerve.these fibers are purely sensory from auriculotemporal nerveBranches auricular branch: upper 2/3 of auricle,external auditary meatus ,outer surface of tympanic membrane articular: posterior T.M.J temporal branch:to temporal region glandular:parotid gland

Lingual branch:innervate lingual mucoperiosteum of mandibular teeth Branches1)ganglionic branch:subandibular ganlgion2)sensory branch to: anterior two third of the tongue floor of the mouth lingual aspect3)Carry taste sensation :from anterior two thirds of tonge via chorda tympani4)Carry parasympathetic fibere to :submandibular and sublingual gland via chordatypani Inferior alveolar nerve:Travels medial to lateral pterygoid and lateroposterior to lingual nerveEnter mandible at the lingulaTravels within the inferior alveolar canal until the mental foramen

branchesMylohoid :supply mylohoid and anterior belly of digastricIncisive :supply pulp and investing structure of lower anterior teethMental nerve:supply skin of chin and lower lipand buccal mucoperiosteum of anterior teeth and first premolar

Local anasthetic techniques preparation for injection1)Patient positionPhysiological the best position for the patient is fully spine ,this provides excellent return of blood from legs to the heart and brain at the same time.and this position reduce but doesnot eliminate the chances of faint which is acommon side effect of dental local anasthesia ,however many patients (especially children)feel vulnerable in fully supine postion.The best compromise to have the patient reclined at 30 degrees to the verticalOperator positionInjection should be performed from siiting position to minimize change in patient position.On the other hand most injections for dental extractions will be administered with operator standing

Preparing in the injection site The patient mouth is prepared by doing scalingThe site of injection carefully cleaned and then sterilized by antiseptic solutionTopical anasthesia is applied after topical antisepticWarm the solution in the cartidge to body temprature by hlding it in hand

The anasethetic carpule should be sterlized from outside by placing it in acolored antiseptic solution.Short needle is used for infiltration anasethsia ,while long needle is used for nerve block anasthesiaBasic procedure during injectionHold the syringe in apen grasp positionThe tissue taut.the tissue at site of injection should be stretched prior to insertion .this can be accomplished in all areas of mouth except the palate(where the tissue are normally quite taut)The needle is gently inserted into mucosa to the depth of the bevel.the needle bevel should be properly oriented toward the bone in case of infiltration anasethsia.The needle should not be bent while inserted within the tissue.Slowly deposit the local anaetshetic solutionCommunicate with the patient during the injectionSlowly withdraw the needle ensuring that it does not inadvertently stab the patient on exit and the needle should be capped immediately with its plastic sheathObserve the patientLocal anasthetic instrumentAnasthetic carpule SyringeNeedleMouth props Retractors

Needle:monobeveled

syringeAccording to material plastic metallicAccording to aspirating aspirating non aspirating syringe

Local anestheticsTypes Ester local anesthetics : hydrolyzed in the Plasma by the enzyme PseudochlinestraseAmide local anesthetics:The primary site of biotransformation of the amide agents is the liver.

Composition of local anethesiaLocal anethetic agentVasocinstrictorAntioxidantPreservativeFurgicidevehicle

Dosing considerationPatient with cardiac history: should limit dose of epinipherine to .04Pediatric dosing clarks rule : maximum dose=(weight of chield in lbs/150 *max adult dose (mg)Simple method=1.8cc of 2%lidocaine/20lbsTopical anestheticUsed prior to local anesthetic injection to decrease discomfort in non sedated patientsLocal anesthetesia techniquesMaxillary anesthesia3 types of anesthsia in maxilla -field block(ring block) -infiltration -nerve block(regoinal block)

Local infiltration anesthesiaSignifies the deposition of the anesthetic solution in close proximity of the area need to be operated on.The effecacy of an infiltration depends on the permiability of the tissues,in particular the bone,through which the analgesic solution has to passTherefore in the whole maxilla where the bone is relatively permeable and the outer cortical plate of bone thin an infiltration injection in nearly always effective

Buccal and labial injectionNeedle: 25mm is recommendedTarget area:mucobucal fold of gingiva (apical region of the tooth)Insertion: 45* to the alveolar bone &should touch bone with bevel facing bone&1.5 ml of solution is insertedPosition of patient:patient is placed with maxillary occlusal plane 45 degree to floorPosition of operator:in front of the patient

Labial infiltration

Labial infoltration

Inaccurate needle insertion parralel to long axis of teeth

Infiltration aneshtesia(subperiostal anesthesia)

Palatal injectionInsertion:midway between gingival margin and midline of the palate needle should be at righ angel to the vault of the palate so the needle is inserted from opposite site and only .3 ml is slowly injected to avoid pain and ulceration

Field blocks It is atype of submucous infiltration anesthsia.In this technique the anesthetic solution is deposited periphrally and circumferentially by multiple injection around the regoin being involved in tumor or for example when doing incision and driange to evacuate a suppurative swelingRegoinal(nerve)block anesthesiaLocal anesthesia is deposited close to main nerve trunk,usually at distance fro, the site of opertive interventionExample .posterior superior alveolar -infraorbital -nasopalatine -greater palatine -anterior superior alveolar nerve -middle superiro alveolar nerve Posterior superior alveolar nerve(zygomatic,tuberosity or posterior infraorbital injection)Injection site:distal aspect of maxillary tuberosity above and behind the third molarNeedle: 25-27 guage long needleSyringe:aspirating anesthestized area1)Upper molars except mesiobucccal root of first molar2)Associating periodontal membrane3)Investing alveolar bone4)Neighbouring buccal mucosa5)Maxillary antrum

Anesthetized areaetechnique1)Mouth should be partly closed2)Needle is inserted opposite the mesial root of the first molar at the deepest part of the mucobuccal fold3)Needle passes around the curvature of the posterior part of maxillary tuberosity4)The needle should be kept close to the bone to avoid entering the pterygoid venous plexus or blood vesselConfirming the anesthesiasubjective find:no subjectiveobjective findings:probing doesnot lead to pain

The most frequent errors in making posterior superior alveolar injectionFailure in getting needle in 45 degrees to sagittal planeFailure to have the syringe in aplane right angle to the occlusal planeFailure to guide the patient to partially close his mouth so that the coroind process may move back out of the wayThis result in no anesthsia except in the cheek(cheek numbness os aproof of incorrect angulation) .the also lead to hematomas result from piercing of one of the viens that is making up to pterygomaxillary plexus of viens.They also lead to eccymosis resultin from hemoglobin breakdownTreatment:cold fomentation for the first 24 hours the hot application in any form

Improper angulation of the needle ,the pterygoid venous plexus in entered with aresultant hematoma

Middle superior alveolar nerveUsed to:anesthesize maxillary premolar,corresponding alveolus and buccal gingival tissueIt might be absentUsed if infraorbital block fails to anesthetize premolarInsertion:height of mucobuccal fold in area of 2nd premolar

Wrong angulation of the needle

Anterior superior alveolar nerve block techniqueUsed to anesthetize maxillary canine,lateral,centralInsertion:mucobuccal fold

infraorbital nerve blockSolution is deposited at the orifice of the infraorbital foramen and will diffuse along the canal to involve both anterior and middle superior alveolar nerve area anesthesized1)Pulps of maxillary premolars and anteriors and mesiobuccal root of maxillary premolar2)Buccal mucoperiosteum from midline to the area of maxillary second premolar3)Lower eyelid ,lateral aspect of nasal skin tissue and skin of infraorbital regionNeedle:25-27 guagesyringe :aspirating

technique1)infraorbital ridge is palpated and infra orbital notch located with the tip of index finger which then moves downward to lie over the infraorbital foramen2)the tip of the needle is directed towards the foramen using any of 2 approach:Intraoral approach1)direct the syringe in the line passing from mesioincisal angle of the central incisor and to the apical region of root of canine2)the needle is inserted at about 5 mm out in the mucobuccal fold above the tip of the root of the canine3)the needle is pushed till it contacts the boundary of the foramen

Intraoral approach

Intraoral approachA vertical imaginary line is drawn from the inner canthus of the eye until it intersects with another imaginary line drawn in the mucobuccal fold forming right angleA 25 guage needle is inserted in the mucobuccal fold about 5mm lateral to the maxillary alveolar bone directing it to bisect this imaginary right angle

Extraoral approachWhen the intraoral approach technique is contraindeicated for any reason such as infection at the site of insertion of the needleThis is basically similar to the intraoral technique but the distance to be traveled by the needle is considerably less

Nasopalatine nerve block(incisive canal injection)This is painful injection so it is better to give afew drops of anesthesia before proceeding with the rest of the injectionThe aim is to anesthetize the nasopalatine nerve inside the incisive canal area anesthesized1)Palatal alveolar plate opposite six anterior teeth2)Overlying mucoperiosteumtechniquePoint of needle insertion:marked by the incisive papilla in the midline ,one cm posterior to the central incisorDirection of the needle parralel to the long axis of maxillary central incisor0,5 ml of solution is injected very slowly

Needle:25-27 guageshort needlesyringe :non aspirating

Greater palatine nerve blockThe aim is to block greater palatine nerve as it comes out of its foramenIts foramen usually lies distal to the upper 2nd molar but it can be more anterior area anesthesized1)Palatal mucoperiosteum from maxillary first premoalar to the maxillary third molarDetection of greater palatine foramenThe index finger is moved(with slightly pressure) from palatal area opposite to maxillary first molar backwards until a bleaching of mucosa occursThe needle in inserted in the bleached area,adrop is felt(greater palatine foramen)

Needle:25-27 guageshort needlesyringe :non aspirating

Maxillary nerve blockThe purpose of this technique is to anesthetize the maxillary division of the 5th cranial nerve as it passes from the foramen rotundum through the pteryg-maxillary space to the post infra orbital foramen thus completely anesthetizing the periapical nerve supply to the maxillary teeth on that siteThe technique is exactly the alveolar nerve injection except that the needle is advanced for adepth of inches &2 c.c of anesthetics solution are slowly injectedindicationsWhere local nerve blocks,such as infraorbital techniques are contraindicated because of infectionFor diagnostic purpose (neuralgia..tics..causalgias)When analgesics of the entire distributed of the maxillary nerve is required for surgery such as that involving the antrum,removal of adeeply buried upper third molar.the bilateral use of this technique will achieve complete anesthesia of the maxilla for extensive surgery required when dealing woth lesions such as malignant tumoursThe maxillary nerve may be blocked by three different techniques1)posterior infraorbital injection,the nerve being blocked before it enters the infraorbital canal 2)by passing aneedle up the greater palatine canal to allow the analgesics solution to reach the infraorbital groove3)by an extraoral approachPosterior infraoorbital approachNeedle:42 mm on curved or contra-angled hub attachment is used because of the angulation and the depth of insertion necessary.Area of injection: over the apices of secong molar and little distance away from bone in order to clear the zygomatic processtechnique1):needle is injected over the apices of secong molar and little distance away from bone in order to clear the zygomatic process 2)The needle pass upward and inwards till reaching the sphenopalatine fossa with an angle 30 degrees3)Four ml of anesthetic solution is depsoited

Greater palatine canal approachArea of insertion: up the greater palatine canalTarget area: the solution passing out of its superios aspect to reach the maxillary nerve in the region of the infraorbital fissure.The greater palatine nerve and also the descending palatine artery and vien are contained within the relatively narrow confines of the canal and trauma to these structure is bound to result when the needle in insertedtechniqueThe approach is made from the opposite side of the mouth,the needle being gently inserted and asmall quantity of solution infiltrated,sufficient time being allowed t elapse for this to take effect.The foramen may be identified with the needle which enters the canal ,passing upwards and backwards at an approximate angle of 45 degree to the occlusal plane of the upper teethWhen depth of 3 mm is achieved aspirtion is performed and 2ml of solution is slowly deposited allowing plenty of time for it to diffuse through superior aspect of the canal

Extraoral approachTo reach the pterygopalatine fossa from an extraoral approach on has to avoid coronoid so pass needle infront of coronid process or behind it technique1)the zygomatic process is palpated and the midpoint of the depresion on its lower border is marked on the skin2)local anesthesia is now achieved by infiltration in this areaNeedle: heavy guage needle of minumum length of 3 inchDepth: 2 inch (50mm) which should never be exceeded

Mandibular anathesiaInfiltration anterior labial anterior lingual long buccalNerve block: mental nerve blockInferior alveolar nerve blockLingual nerve blockMandibular nerve blockInfiltration technique1)labial injection nerve to be anesthetize : inciseive nerve &inferior dental plexus needle:25-27 guage (short needle) syringe:non-aspirating syringe target area:apical region of the tooth to be anesthetized

Point of needle insertion : the point of intersection of 2 imaginary lines-1st line is vertical line parralel to the long axis of the tooth-2nd line is horizontal line along mucobuccal fold

Direction of needle insertion: 45 degree with the buccal cortical plate of bone

Lingual infiltrationNerve to be anesthetized: terminal branches of lingual nerveNeedle:25-27 guage(short needle)Syringe:non aspiratingThe target area: apical to tooth to be anesthetized lingually

Long buccal infiltration techniqueNerve to be anesthetized: terminal parts of the long buccal nerveNeedle :25-27 guage (long needle)Syringe:non aspirating except when injecting long buccal followinf inferiro alveolar nerve block injectionTarget area: distal to the apical region of the tooth to be anesthetizedDirection of needle: 45 degree with buccal cortical plate of bone

Mental nerve blockArea anesthetized : labial m.m and skin from mental foramen to midlinePosition of the patient: the patient is placed in aposition that when he opens his mouth widely the mandibular occlusal plane is parralel to floorPosition of operator:the operator stands on the right side or behind the patient

Extraoral approach of mental nerve block techniqueWhen treating mental neuralgia ,facial trauma, or other painful conditions involving the mental nerve,atotal of 80 mg of depot-steroid is added to the local anesthetic with the first block and 40 mg of depot-steroid is added with subsequent blocks

Inferior alveolar nerve block techniqueAim: to block the inferior dental and lingual nerve by deposition of the anesthetic solution around them when they are in the pteygomandibular space and before entrance of inferior alveolar nerve to the mandibular foramenPoint of needle insertion1)the index of the left hand is placed in the mucobuccal fold opposite the premolar area2)the external oblique ridge and the anterior border of the ramus are located3)the greatest depth of the anterior border of the ramus which is the coronoid notch is located4)the index finger is rotated lingually to occupy the retromolar triagnle and fingernail faces the lingual side5)with fingernail on this position the finger tip will rest on the internal oblique ridge6)the point of needle insertion is 5 mm infront of the middle of the tip of the index finger7)asyringe with long needle is held over the premolar region of the opposite side and parralel with the mandibular occlusal plane8)the needle is inserted to adepth 20-30mmtill it touch bone9)1.2 ml of solution is deoposited slowly10)the needle is withdrawn about 10 mm and 0.3 ml of solution is deposited

Mouth must be opened for this technique

Local anethesia given too far posteriorly

Long buccal nerve:Anesthetized by eitherSoft tissue infiltrationLong buccal nerve block: 0,3-0.5 ml of anesthesia is deposited in the midpoint of the retromolar triangle between external and internal oblique ridges

Inferior alveolar nerveLingual nerve

Errors during inferior alveolar nerve block techniqueHigh injection:Numbness of ear due to injection near the auriculotemporal nerveTrismus due to injection into lateral pterygoid muscleToxicity due to injection into pterygoid plexus of viensLow injectionTrismus due to injection in to medial pterygoid muscle Toxicity due to injection in to posterior facial vien

Low and deep injectionFacial paralysis due to injection into substance of parotid gland(facial nerve)

High injectionLow injection

Mandibular nerve block1)gow gates technique2)akinosi techniqueGow gates techniqueAim to anesthetize the inferior alveolar,mental nerve,incisive,lingual,mylohyoid,auriculotemporal and buccal nervesTarget area:the lateral aspect of the neck of the condyle1)the patient is instructed to extent the neck and open the mouth as wide as possible2)extraoral landmarks: intertragic notch corner of the mouth3)The index finger is used to retract the tissues4)tissues at site of injection are preapared5)the barrel of the syringe is placed on the side opposite to that of injection6)needle penetration occurs at asite just distal to the maxillary second molar and at aheight equal to the palatal cusp of the second molar7)the needle is aligned to aplane extending from corner of the mouth to the tragus8)needle is slowly advanced till bone is contacted9)1.8 ml of solution is deposited

advantagesIncreased succes rateConstancy of landmarksDecreased positive aspiration rateDecrease incidence of trismusOnly one injection is requiredGow gates technique

Gow gates technique

Gow gates

2)Akinosi techniqueAim to anesthetize the inferior alveolar,mental,incisive and buccal nerveTarget point:area between the vertical ramus and maxillary tuberosity1)the patient is askes to close teeth2)cheek is distended using the fingers of the left hand3) the mucosa buccal and distal to upper third molar is wiped4)the needle is positioned at the level of the maxillary marginal gingiva with the barrel parralel to maxillary occlusal plane5)the needle pentrate the tissues in the embrasure between the vertical ramus and maxillary tuberosity6)2.5-3 cm of needle is buried in the tissueadvantagePainlessOne prick of the needleRapid onsetCan be used in patients suffering from trismusAkinisi technique

Akinosi technique

Akinosi technique

Local complications of local anesthsia1-Needle breakage2-pain on injection3-Burning on injection 4-persistent anesthesia (paresthesia 5-Trismus 6-Hematoma 7-Infection 8-Edema . 9-Sloughing of tissues ). 10-lip chewing 11- Facial nerve paralysis 12-Postanesthetic intraoral lesions 13-Syncope (fainting )Systemic complicationAre those complications resulting from the absorption of the anesthetic solutions. They are :-1-Toxicity2-Idiosyncrasy 3-AllergyAnaphylactic reaction

Complications associated with needle insertionFainting and syncopeMuscle trismusPainEdemaInfectionBroken needleProlonged anesthsiaHematoma formationSloughing and ulcerationBizarre neurological symptoms