Escolar Documentos
Profissional Documentos
Cultura Documentos
net/publication/257793071
CITATIONS READS
3 288
2 authors, including:
Ashish Chakranarayan
Indian Navy
20 PUBLICATIONS 49 CITATIONS
SEE PROFILE
Some of the authors of this publication are also working on these related projects:
A conservative surgical approach in the management of longstanding chronic protracted TMJ Dislocation: case report and review of literature View project
All content following this page was uploaded by Ashish Chakranarayan on 23 October 2015.
ISSN 0972-8279
Volume 12
Number 1
1 23
Your article is protected by copyright and all
rights are held exclusively by Association of
Oral and Maxillofacial Surgeons of India. This
e-offprint is for personal use only and shall
not be self-archived in electronic repositories.
If you wish to self-archive your work, please
use the accepted author’s version for posting
to your own website or your institution’s
repository. You may further deposit the
accepted author’s version on a funder’s
repository at a funder’s request, provided it is
not made publicly available until 12 months
after publication.
1 23
Author's personal copy
J. Maxillofac. Oral Surg. (Jan-Mar 2013) 12(1):113–116
DOI 10.1007/s12663-011-0310-1
ORIGINAL PAPER
Received: 5 August 2011 / Accepted: 5 October 2011 / Published online: 19 October 2011
Ó Association of Oral and Maxillofacial Surgeons of India 2011
Abstract One of the most commonly used local anes- is reported to have been associated with risks and compli-
thetic techniques in dentistry is the Fischer’s technique for cations such as neural or vascular injury, intravascular
the inferior alveolar nerve block. Incidentally this tech- injection and failure to achieve adequate anesthesia.
nique also suffers the maximum failure rate of approxi- Improper technique was deemed to be one of the major
mately 35–45%. We studied a method of inferior alveolar factors contributing to the failure of a desired result which
nerve block by injecting a local anesthetic solution into the has been reported as high as thirty-five to forty-five percent
pterygomandibular space by arching and changing the [2–4] In our study, we altered the insertion angle of the
approach angle of the conventional technique and esti- needle by arching it to achieve a near perpendicular angle
mated its efficacy. The needle after the initial insertion is with the ramus, resulting in a more accurate deposition of the
arched and inserted in a manner that it approaches the anesthetic solution thus lowering the incidence of failure to
medial surface of the ramus at an angle almost perpen- achieve desired anesthesia.
dicular to it. The technique was applied to 100 patients for
mandibular molar extraction and the anesthetic effects
were assessed. A success rate of 98% was obtained.
Aim
Keywords Inferior alveolar nerve block
The aim of the study was to assess the efficacy of the
Failure rate Arched needle
arched needle technique while administering an inferior
alveolar nerve block.
Introduction
The most commonly practiced inferior alveolar nerve block Materials and Methods
is the Fischer’s technique [1, 2] (Fig. 1). The success of
inferior alveolar nerve block largely depends on deposition The prospective analytical study was carried out at the
of the anesthetic solution in the correct area i.e. in close Division of Oral & Maxillofacial Surgery, Dental Centre,
proximity to the nerve. However, the conventional technique INHS Kalyani, Eastern Naval Command, Vishakhapatnam,
(AP) India from Jan 2009 to Jan 2010. Patients were ran-
domly selected from those reporting to the OPD of Divi-
A. Chakranarayan (&)
sion of Oral & Maxillofacial Surgery, Dental Centre, INHS
Oral & Maxillofacial Surgery, INHS Kalyani,
Eastern Naval Command, Visakhapatnam 530005, Kalyani, Vishakhapatnam, (AP) India with a complaint of
AP, India pain in the lower third molar region. The selection criteria
e-mail: ashish_chakranarayan@hotmail.com included those patients who were clinically and or radio-
logically diagnosed with symptomatic impacted lower third
B. Mukherjee
Periodontology, Dental Centre, INHS Kalyani, molar teeth. However patients requiring other procedures
Eastern Naval Command, Visakhapatnam, India i.e. RCTs or extraction of teeth other than impacted teeth
123
Author's personal copy
114 J. Maxillofac. Oral Surg. (Jan-Mar 2013) 12(1):113–116
Table 1 Complications
S. No Problem areas Number of cases Remedial measures Result
123
Author's personal copy
J. Maxillofac. Oral Surg. (Jan-Mar 2013) 12(1):113–116 115
Discussion
123
Author's personal copy
116 J. Maxillofac. Oral Surg. (Jan-Mar 2013) 12(1):113–116
however it is equipment specific and may not be meant for 3. Potocnik I, Bajrović F (1999) Failure of inferior alveolar nerve
inexperienced operators. block in endodontics. Dent Traumatol 15(6):247–251
4. Madan GA, Madan SG, Madan AD (2002) Failure of inferior
After completion of this study the authors have suc- alveolar nerve block: exploring the alternatives. J Am Dent Assoc
cessfully used this technique on more than ten thousand 133(7):843–846
patients for all procedures requiring mandibular anesthesia. 5. Parsons-Smith G, Roberts JM (1970) Facial paralysis after local
dental anaesthesia. Br Med J 4(5737):745–746
6. Rifkind JB (2011) Management of a broken needle in the
pterygomandibular space following a vazirani-akinosi block: case
report. J Can Dent Assoc 77:b64
References 7. Stacy GC (1994) Barbed needle and inexplicable paresthesias and
trismus after dental regional anesthesia. Oral Surg Oral Med Oral
1. Malamed SF (1997) Techniques of mandibular anesthesia. In: Pathol 77(6):585–588
Handbook of local anesthesia, 4th edn. Harcourt Brace, Noida, 8. Hochman MN, Friedman MJ (2001) An in vitro study of needle
pp 228–234 force penetration comparing a standard linear insertion to the new
2. Johnson TM, Badovinac R, Shaefer J (2007) Teaching alternatives bidirectional rotation insertion technique. Quintessence Int
to the standard inferior alveolar nerve block in dental education: 32(10):789–796
outcomes in clinical practice. J Dent Educ 71(9):1145–1152
123