Tuberous anesthesia is the most dangerous, from the point of view of complications, injection technique. At the moment, such a procedure is used infrequently. It is carried out by extraoral and intraoral administration of drugs. Anesthesia is used to anesthetize the region of the upper molars, in particular for blockade of the dimples.
Features of the procedure
The complex anatomical characteristics of the drug administration zone increase the risk of complications and reduce the effectiveness of anesthesia. Consider some points.
In the temporal pterygoid space above the upper jaw is the venous plexus. It occupies the region from the lower orbital fissure to the lower jaw. Accidental puncture of the venous wall causes the formation of an extensive hematoma, which is difficult to prevent.
The introduction of the needle to an insufficient level leads to the fact that the injection of the solution is carried out in the subcutaneous fat. In this case, tubal anesthesia will not be effective at all. Exceeding the depth of insertion of the needle leads to the following consequences:
- The introduction of anesthetic into the area of the optic nerve causes temporary blindness.
- Injecting the drug into the fiber of the orbit causes temporary strabismus.
- The ingress of the solution into the pterygoid muscle causes severe pain after the action of the anesthetic is over.
The tip should not be allowed to slide along the tubercle during the procedure, as perforation of nerves and small vessels is possible.
Pain zone
Tuber anesthesia in dentistry allows you to anesthetize the following areas:
- region of upper molars;
- the periosteum and the mucous membrane of the alveolar process covering it;
- the mucosa and maxillary sinus bone along the posterior wall.
The boundary region of anesthesia passing in the back is constant. In front, it can reach the middle of the first small molar and, accordingly, the mucosa located in this area along the gum.
Intraoral tubal anesthesia according to Egorov
Progress of the procedure:
- The patient’s mouth is half open. The cheek adheres with a spatula.
- By directing the needle section towards the bone tissue, the doctor punctures at the level of the second molar to the bone.
- The needle should be located at an angle of 45 ° to the alveolar bone.
- The needle moves up, back and to the middle, while it is necessary to control its constant contact with the bone. A small amount of anesthetic is released along the way.
- A 2-2.5 cm needle is inserted. The piston is pulled back to check for the absence of a puncture of the vessel.
- If there is no blood, up to 2 ml of the solution is injected. The syringe is removed.
- The patient presses the site of anesthesia to avoid the appearance of a hematoma.
- The full effect of the drug manifests itself over 10 minutes.
If you use a short-acting anesthetic, the procedure will be effective for 45 minutes, if long - up to 2.5 hours. Intraoral tubular anesthesia is performed for outpatient surgery and with simultaneous intervention in several molars.
Extraoral method
Regardless of which side tubular anesthesia is needed, the technique requires the patient's head to deviate in the opposite direction. Before the anesthesia itself, the doctor determines the depth at which the needle will need to be inserted. This is the distance between the lower outer corner of the orbit and the anterior lower angle of the zygomatic bone.
The dentist is located to the right of the patient. A needle is inserted into the anteroposterior angle of the zygomatic bone. It should have an angle of 45 about in relation to the median sagittal plane and a right angle to the trago-orbital line. After the needle is inserted, an anesthetic is injected to the desired depth. Anesthesia develops over 5 minutes.
Preparations
Tuberous anesthesia is performed using local anesthetics:
- Lidocaine is the first derivative of amides, on the basis of which Bupivacaine, Articaine, Mesocaine and other drugs were synthesized. It is used in the form of a 1-2% solution. Lidocaine is a low-cost drug. Contraindicated in patients with organic liver damage.
- Trimecaine is a derivative of amides. In terms of effectiveness, speed and duration of action, it exceeds novocaine several times. Available in the form of solutions of various concentrations. As a side effect of the administration of the agent, pallor of the skin, nausea, and headache may occur.
- The drug "Ultracain", the price of which is 1.5-2 times higher than that of other representatives of local anesthetics (50 rubles per ampoule), has a greater advantage in use. High diffusion ability and good duration of action allow its use not only in surgical, but also in orthopedic dentistry. How much is Ultracain? The price of the drug (for this type of anesthesia in the dental clinics of Russia will have to pay from 250 to 300 rubles) is due to its foreign origin. Analogs - Artikain, Alfakain, Ubistesin.
All drugs are used in combination with a vasoconstrictor (adrenaline). When choosing a drug, a specialist determines individual tolerance and the maximum dose, takes into account the patient’s age, as well as the presence of pregnancy and associated pathologies.
Complications of the procedure
Tube anesthesia, reviews of which are ambiguous (patients note an excellent analgesic effect, but some complain that numbness does not go away for up to 5 hours, plus the side effects mentioned above are not to the liking of many), should be performed by a highly qualified specialist, able to take into account all the necessary nuances of the event. Some of the possible complications have already been considered. Time should be devoted to their prevention.
Vascular injuries and hematomas in the area of pain relief can be prevented. For this purpose, during anesthesia, the contact of the needle with the bone tissue should not be lost and no more than 2.5 cm should be inserted. After the needle is removed, the infiltrate formed by the injected anesthetic is massaged upward beyond the maxillary tubercle. Tuberous anesthesia is allowed only in the absence of inflammatory processes at the injection site.
Danger of the patient becomes getting the solution into the bloodstream. Its toxicity increases by 10 times, and the action of the vasoconstrictor - by 40. The patient may experience shock, collapse, fainting. To prevent such a complication, the syringe plunger is pulled back before injecting the anesthetic. This makes sure that the needle does not enter the vessel. If blood appears in the syringe, you need to change the direction of the needle and only then inject the drug.
Violation of aseptic rules during the procedure can lead to infection. Introducing the needle into the mouth, you need to make sure that it does not touch the tooth. Plaque will lead to the development of phlegmon.
Conclusion
Due to the large number of complications and the complexity of the technique, tubal anesthesia is rarely practiced. The choice of anesthesia should be entrusted to a specialist.