Torus anesthesia, or Gow Gates anesthesia, is a type of local anesthesia in which the anesthetic is injected into the torus, the mandibular roller. During the implementation of this injection, the needle should be in one position, which greatly facilitates the development of this technique of anesthesia.
The indications and guidelines for Gow Gates anesthesia are presented below.
Sensitivity Reduction Areas
With the introduction of an anesthetic in a patient, the sensitivity threshold decreases:
- mandibular department;
- chin area;
- alveolar bone ;
- skin of the front part;
- oral mucosa.
What is the difference?
Gow Gates anesthesia differs from the mandibular standard in that the needle during administration of the drug is at a constant angle. After the anesthetic is injected into the mandibular elevation, the medicine immediately begins to act on the buccal, lingual and mandibular nerve endings.
Anatomical features
The mandibular roller is formed of two bone cords of the coronoid and condyle processes, which are located above and in front of the bone tongue. Three nerve endings that lose their sensitivity go along the slopes of this formation. Due to this effect, sensitivity is disturbed in the region from the second premolar to the second molar in the middle, which makes it possible to painlessly perform dental procedures and operate on problem areas of the oral cavity.
What are the indications for go-gates anesthesia?
Cases for applying this technique
The use of torusal anesthesia is possible in the following cases:
- opening of boils, abscesses, phlegmon and other purulent formations inside the oral cavity;
- conducting surgical interventions in the field of the dentition of the lower jaw;
- removal of incorrectly formed teeth, as well as defects from the location;
- extraction of wisdom teeth;
- imposition of tires in case of fracture of the lower jaw;
- depulpation;
- surgical manipulations to remove a cyst, tumor and mutilated bones in the mandibular region.
What happens with this?
According to the description of anesthesia according to the Gates, before its implementation, the patient must open his mouth as wide as possible. With incomplete opening, the lower jaw can move around the frontal axis. The articular disc is located in the articular fossa, and the mandibular opening is shifted back and down. As a result of this, the mandibular nerve begins to stretch between the mandibular and oval openings. That part of it, which is associated with the mandibular opening, is shifted to the temporomandibular joint somewhat closer.
At the second stage, with further opening of the mouth against the background of the articulated movement of the articular head in the lower floor of the joint, the cartilaginous disks together with the heads of the condylar process glide forward and exit onto the articular tubercle.
In the process of further maximum lowering of the lower jaw, movement is observed only in the lower floor of the joint along the frontal axis. So, the closest location of the mandibular nerve and the target point occurs already at the second stage, when the head of the condylar process moves forward to the articular tubercle. The subsequent maximum opening of the mouth is impractical. The process of transition of the condylar process forward is easily determined, while the head is palpated slightly better, which satisfies the main position.
Varieties of technology
Torus analgesia is performed using several techniques:
- according to go gates;
- according to Legardy;
- according to Akinosi Vizari.
In addition, the anesthetic may be administered using an apodactyl technique or by an extraoral method.
Go Gates Anesthesia was developed in 1973 by the Australian dentist Go Gates. The technique for performing anesthesia is rather complicated, however, it is endowed with specific guidelines and is effective in 97% of cases. The peculiarity of this technique lies in the change in the relative position of the destination for the anesthetic and the mandibular nerve with the necessary opening of the mouth. In the process of opening, the lower jaw rotates along the frontal axis in the same articular layer, as a result of which the head of the condylar process using the cartilaginous disc begins to advance forward on the articular elevation.
The described Gates Gates anesthesia in dentistry does not require careful visual control and spatial imaging. It is successfully carried out in the presence of moderate coordination of movements, similar to information with closed eyes of the index fingers of two hands.
Thus, an analysis of the features of this technique of local anesthesia of the mandibular nerve according to the Gow-Gates mechanism explains its safety and effectiveness, and also allows you to clarify a number of provisions in the technique of its implementation.
Gow Gates Anesthesia Complications
Of the possible complications in some cases, the development of a hematoma at the injection site and difficulties with the respiratory process are observed. In this case, the patient may experience psychological discomfort, which in some cases implies the occurrence of a panic attack.
Disadvantages and advantages
The positive aspects of the technique of implementing torusal anesthesia according to Gates:
- high efficiency from 90 to 98%;
- insignificant degree of possible negative consequences;
- clear definition of landmarks.
The main disadvantage of this anesthesia technique is the long period the effect is achieved, approximately 5 minutes longer than when using other methods of anesthesia.
Technique for the implementation of the blockade of the testicular lower nerve
In this case, the sensitivity of the following nerves decreases:
- reed;
- lower hole;
- maxillohyoid
- buccal;
- ear-temporal.
The step-by-step instruction is as follows:
- The patient is located in a semi-horizontal or horizontal position, which is not only convenient for anesthesia according to the Gows method, but also the most physiological in the prevention of emergency conditions in a patient due to all kinds of reflex disorders of the blood vessel tone. The specialist is placed on the right side of the patient.
- The most accurate location of the doctor will be determined by the direction on which the patient is supposed to undergo anesthesia. In this case, the patient’s head must be asked to turn a little from the dentist due to similar considerations.
- With the patient's open mouth, the mucous membrane is treated at the site of the alleged injection in the pterygo-maxillary cavity, after drying, and then anesthetizing with the help of an anesthetic. The drug is applied under anesthesia according to Gows-Gates pointwise, and after 2-3 minutes its residues should be eliminated.
- Additional methods for reducing tissue trauma and preventing a vascular reaction during the injection may be: before piercing the mucosa, the patient is asked to take a deep breath and hold his breath for a short time, which helps to reduce the number of possible unwanted movements of the patient in the process of moving the needle to the destination . Additional preliminary ventilation of the lungs during the deep inspiration period increases the oxygen saturation of the blood and leads, as a rule, to a slight increase in the heart rate as a result of the cardio-respiratory reflex, which increases blood vessels.
- The specialist takes the syringe in his right hand, places it in the corner of the oral cavity, opposite the side of the injection, drawing away the tissues of the mucous cheek on the side of the injection with the thumb, which is placed in the mouth. After that, the dentist asks the patient to open his mouth wide, controlling the level of its opening upon reaching the articular tubercle of the condylar process, the movement of which, as already described, can be traced by sensation under the index finger placed in the external auditory meatus or in front of the tragus. The needle is sent to the pterygo-maxillary zone, the medial tendon of the temporal muscles in the area where application anesthesia was previously performed .
- After holding the patient’s breathing, the mucosa is punctured, and the needle slowly moves all the way to the bone tissue — the lateral parts of the condylar process, behind which the tip of the index finger is localized. Reaching the bone should match the location of the end of the needle at the destination. If this did not happen, the needle begins to slowly withdraw to the surface of the mucosa, its orientation is corrected and the progress is repeated.
- In case the target point is successfully reached, the needle is retracted 1 mm back and an aspiration test is performed. With negative results of this test, 1.7-1.8 ml of anesthetic solution is slowly injected, while the attention of a specialist should be focused on the patient's condition.
- After the introduction of anesthetic, the needle is slowly removed from the tissues. After the injection, the patient is asked to not close his mouth for another 2-3 minutes so that the local anesthetics soak the surrounding tissue in the anatomical location that they have when opening the mouth. In most cases, with this type of anesthesia, the buccal nerve is also blocked. It is very advisable to anesthetize the buccal nerve before surgery, because this will not cause concern to the patient in case of insufficient blocking of this nerve.
Reviews
Reviews about this anesthesia technique are very positive. This is observed both by dentists and patients. Patients say that the injection is almost painless, and after it the sensitivity is violated enough so as not to experience discomfort during surgical manipulations in the oral cavity. Experts also speak favorably about this technique of pain relief. They say that it is carried out quite easily.
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