Tag: Local Anesthesia

Complications of Local Anesthesia

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🔷 Local Complications:

  • Needle breakage
  • Persistant anesthesia or paresthesia
  • Facial Nerve Paralysis
  • Trismus
  • Soft-tissue injury
  • Hematoma
  • Pain on injection
  • Burning on injection
  • Infection
  • Edema
  • Sloughing of tissues
  • Post-anesthetic intraoral lesions

🔷 Systemic Complications:

  • Vasodepressor syncope
  • Over dosage (toxic reaction)
  • Allergy
  • Psychogenic reactions

Clinical Tip💡

👉🏻Several preventive measures can be followed:📝

1) Select a local anesthetic with a duration of action that is appropriate for the length of the planned procedure.

2) Advise the patient and accompanying adult about the possibility of injury if the patient bites, sucks or chews on the lips, tongue and cheek. They should delay eating and avoid hot drinks until the effects of the anesthesia are totally dissipated.

3) Reinforce the warning with patient stickers and by placing a cotton roll or rolled up gauze (“Bite on the ghost”) in the mucobuccal fold if anesthesia symptoms persist.

4) The management of soft tissue trauma involves reassuring the patient and parent (it’s okay if the tissue turns white), allowing up to a week for the injury to heal, and lubricating the area with petroleum jelly or antibiotic ointment to prevent drying, cracking and pain.

References: Internet; Handbook of LA, 6e by Stanley F Malamed

Dr. Mehnaz Memon🖊

Inferior Alveolar Nerve Block (IANB)

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➡️ The inferior alveolar nerve along with its 2 terminal branches – the mental and incisive nerves innervates the mandibular teeth as well as the buccal soft tissue anterior to 1st molars. This also provides anesthesia to the lip and chin on the side of injection.

➡️ Buccal Nerve – Buccal mucosa and cheek from 3rd molars to 1st molar.

➡️ Structures/Landmarks:

  1. Coronoid Notch
  2. Internal Oblique Line
  3. Lingula
  4. Pterygomandibular raphe
  5. Retromolar triangle
  6. Retromolar fossa
  7. Mandibular fossa
  8. Posterior border of ramus
  9. Occlusal plane

➡️ A plane passing through the deepest portion of coronoid notch parallel to occlusal plane will pass just over the lingualar notch. This determines the height of injection.

➡️ The internal oblique line serves as the attachment for deep tendon of temporalis muscle is important as it determines the AP point of injection.

➡️ Also the distance from internal oblique line to lingula is 9-11 mm in most adults provides the clinician a reference of depth of needle penetration.

➡️ The finger is placed to the depth of coronoid notch to determine vertical height of injection.

➡️ The barrel of the syringe is positioned from opposite the premolar region parallel to occlusal plane with the needle at the predetermined height.

➡️ Posterior to Internal Oblique line and anterior to lingula – contact of the needle.

▪️Clinical Tip👇🏻

References: Internet; Handbook of LA, 6e by Stanley F Malamed; MONHEIMS LOCAL ANESTHESIA AND PAIN CONTROL IN DENTAL PRACTICE 7ED