Visualization of Local Anesthetic in the Pterygomandibular Space (PMS): Educational Module for Inferior Alveolar Nerve Blocks (IANBs)
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Authors
Cesario, Robert
Issue Date
2023
Type
Thesis
Language
en_US
Keywords
IAN , IANB , Intraoral Injections , PMS
Alternative Title
Abstract
INTRODUCTION. Local anesthesia is a critical part of dentistry and a skill clinicians will utilize throughout their careers. Local anesthetic prevents the depolarization of neurons, thus blocking the transmission of nerve impulses to the brain and ultimately the perception of pain. Inferior alveolar nerve (IAN) blocks have the highest incidence of failure of any block injections, ranging from 15-20% (AlHindi, Rahsed, and AlOtaibi, 2016, p. 85). Factors, such as inflammation, can contribute to the high failure rate, but the most common cause is poor technique (AlHindi et al., 2016, p. 85). Understanding anatomical relationships, variations, and proper technique are critical to mastering the IAN block. This project aims to develop an educational module for IAN blocks in the hope of decreasing the failure rate, increasing one’s confidence and therefore the success rate of the block while minimizing discomfort to the patient. MATERIALS AND METHODS. A 2% methylene blue (PBS) solution was administered into the pterygomandibular space (PMS) in an unembalmed cadaver oral cavity. The methylene blue solution served as a marker for local anesthetics to visualize the spread in the PMS. A 27-gauge needle, 1.8mL carpule, and syringe were used to administer the solution. Following the injection, the PMS was dissected to expose where the dye had aggregated. A Vinca (DCLA-0605) caliper was used to measure the dispersion of the solution within the PMS. RESULTS: The methylene blue (PBS) dye solution aggregated in the area of the inferior alveolar and lingual nerves, indicating a successful injection. The mandibular foramen was used as a starting point for measuring the dispersion of the dye superiorly (37.55mm) where the lateral pterygoid muscle inserts into the neck of the mandible. Measurements were also taken in an anterior-posterior direction, measuring from the anterior border to the posterior border of the ramus (29.51mm). CONCLUSIONS. This educational module will provide insight into IAN blocks. Although this project’s goal was to visualize IAN blocks, future research regarding using pre-clinical models (i.e., fresh cadaver heads, simulations, etc.) in dental school curriculums may provide future clinicians with the tools necessary to administer this block successfully.
Description
2023
Citation
Publisher
Creighton University
License
Copyright is retained by the Author.
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