Thoracic anesthesia in dentistry: technique, anesthesia zone

Anesthesia is thoracic, or anesthesia by Weisbrem,It acts on the entire mandibular zone, including mucous membranes, teeth, cheek skin, chin area and alveolar process. The difference between this method and the traditional one is that the doctor introduces the needle directly, without any changes in the slope. Torus anesthesia is a modified mandibular anesthesia.

Indications for such a procedure

Torus method of anesthesia is used in such cases:

painful dental therapy in the dental chair (from caries or tooth extraction on the lower jaw);
period of application of gusmatics in jaw trauma;
removal of wrongly formed teeth;
surgical intervention for the removal of cysts, as well as other tumors on the lower jaw (such an exercise is also carried out under local anesthesia);
tearing out a fully grown tooth stuck in the bone;
opening of abscesses (purulent formations), however in such a situation it is necessary to combine several types of anesthesia;
cutting the hood of wisdom tooth on the lower jaw.

Need to know

For the correct implementation of anesthesia,see the topography of the mandibular opening, which is located on the hidden surface of the jaw branch (from the facial region of the maxillary process in the 15 mm interval, from the back side - 13 mm, from the inner edge of the lower jaw - 27 mm, and from its notch - 22 mm). In adults this hole is located on the chewing surface of the lower molars, while in children and the elderly it is slightly lower.

In front, the slot is protected by a bone protrusion, socalled the tongue of the mandibular zone. Therefore, to make it more convenient to perform thoracic anesthesia, the injection is made in place, 0.7-1 cm above the level of the opening, that is, above the surface point of the tongue of the lower jaw. At this point, the nerve is located in the bone groove, where there is a porous tissue, allowing the drug to be freely dispensed.

What are the goals of mandibular anesthesia

Conductive anesthesia on the lower jaw byWeisbræm is often called torusal. Unlike a typical technique, the task of this method is to reach the mandibular elevation, where the basis is the bone formation - the union of the condyle and coronary tissue. It is located on the closed external part of the lower jaw closer to the bone tongue. This lumen is made of fiber, in which the buccal, mandibular and lingual nerve trunks are connected. Mandibular anesthesia is performed by intraoral and extraoral methods. With intraoral access, two methods of such anesthesia are used: palpation and apodactyl (without palpation).

Palpator way

Anesthesia with the help of palpation. To do this, you need to know the location of the temporal ridge (this is the reference point for the needle puncture) and the posterolar groove by the sensation method. The temporal ridge is an osseous cushion that extends from the coronary sprout to the lingual wall of the alveolar zone of the lower jaw. In the inner part this scallop is divided into open and closed rods. They form a small patch - the posterolar triangle.

Such anatomical growth is requireddistinguish with the posterolar fossa, which lies between the temporal ridge and the facial region of the lower jaw. It follows that the posterolar cavity is located on the side of the triangle. If thoracic anesthesia is performed on the right, then the osseous landmarks are probed with the index finger of the left hand, if on the left - with the thumb of the same hand.

Torus anesthesia: technique

The patient is told to open his mouth to the maximum and feel the anterior margin of the appendage of the lower jaw at the level of the distal trait of the crown of the third molar (if it is absent, then behind the second molar).
Moving the finger a little to the inside, the doctor finds the temporal scallop, then sets the finger in the posteroluminal cavity, which is narrowed by these anatomical formations.
Fixing a syringe on the surface of premolars withOn the other hand, the specialist injects with a needle near the temporal ridge 0.8-1 cm above the masticatory level of the third molar, then moves the needle to the outer and inner parts.
Now the technique of thoracic anesthesia goes like thisway: the needle reaches the bone at a depth somewhere 0.5-0.7 cm, in this zone a small dose of medication is administered to anaesthetize the lingual nerve located in the front of the lower alveolar nerve.
Then the syringe moves to the site of the incisors, and the needlemoves higher, that is parallel to the closed external part of the appendage of the lower jaw, to a depth of 2-3 cm to the bone groove where the alveolar nerve is located, and the rest of the anesthetic is injected.

When using today's medications of the amide group "Ultrakain DS Forte", the dose of the injected agent is approximately 2 ml.

Apodactyl technique

The main guideline for carrying out this methodthe pterygo-mandibular fold is considered, which is well detected. It can be narrow, broad or medium in width, located to the inside of the temporal scallop.

How is the procedure performed

Torus anesthesia in dentistry is carried out as follows:

The dentist tells the patient to open his mouth wide, then fixes the syringe at the level of the lower jaw.
Prick needle is carried out in the outer slopewing-mandibular fold to the center between the chewing planes of the lower and upper molars (if they are absent - then in the middle of the distance between the crests of the alveolar region and the sprout).
Further, the specialist promotes the needle to the external andthe inner side of the fold before joining with bone fiber to a depth of 1.5-2 cm, which introduces a medicine for analgesia of the lingual and lower alveolar nerves. The pterygo-mandibular fold is less accurate than the temporal ridge.

Extraoral access

Anasthesia of the thoracic mandible is performed in this way, if, for example, there are difficulties with opening the mouth. How the event is carried out:

The projection of the mandibular slit onskin. This hole is located in the center of the strip running from the surface margin of the tragus of the auricle to the intersection of the face of the chewing muscle.
A needle prick is made at the base of the jaw by 1.5 cm to the front edge from its angle.
Then the needle moves slightly higher by 3-4 cm along the closed surface of the appendage of the mandibular cavity parallel to its back side. At the time of passage of the needle, it is necessary to hold its contact with the bone.
At the end, an anesthetic is administered. Then, having advanced the needle upward by another 1 cm, the remaining anesthetic drug poured in, turning off the nerve of the tongue.

Place anesthesia

The thoracic anesthesia is primarily performed in order to anesthetize several zones in the oral cavity immediately, namely:

lingual and inferior alveolar nerve;
chin skin in anesthesia;
all teeth of the lower jaw half;
mucous and skin of the lower lip;
bone tissue of the alveolar side and part of the body of the lower jaw;
mucous membrane of the hyoid zone and 2/3 of the anterior part of the tongue;
mucous wall of the alveolar point from the lingual and vestibular margin.

Some part of the mucosa of the alveolarthe portion of the lower jaw within the boundaries from the center of the second premolar to the middle of the first molar is innervated. To completely anesthetize this place, mandibular anesthesia is performed as follows: 0.5 ml of the drug is additionally injected into the intermediate bend according to the type of infiltration anesthesia.

Anesthetic result with such anesthesiastarts after 15-20 minutes. The duration of anesthesia is approximately 60-90 minutes. The severity of anesthesia in the incisors and canines is much lower due to anastomoses from the opposite side. With this anesthesia, drugs such as Novocaine, Trimekain, Ultrakain, or Lidocaine are used.

Complications

Anasthesia torusal can also bring harm, namely:

formation of a hematoma;
fracture of the injection needle;
numbness of pharynx tissues;
neuritis of the lingual and alveolar nerve;
damage to the hidden pterygoid muscle with further formation of the lower jaw contracture.

The above complications occur whenviolation of the technique of pain management. Thus, carrying out thoracic anesthesia - the procedure is not simple and requires a high qualification of the dentist.