lroubal@med.muni.czlroubal@med.muni.cz 11 OralOral andand maxillofacialmaxillofacial surgerysurgery II.II. AnaesthesiaAnaesthesia SutureSuture lroubal@med.muni.czlroubal@med.muni.cz 22 AnaesthesiaAnaesthesia TopicalTopical ByBy injectioninjection -- InfiltrationInfiltration -- NerveNerve blockblock lroubal@med.muni.czlroubal@med.muni.cz 33 NerveNerve blockblock anaesthesiaanaesthesia ForamenForamen mandibularemandibulare ForamenForamen mentalementale ForamenForamen palatinumpalatinum majusmajus ForamenForamen incisivumincisivum ForamenForamen infraorbitaleinfraorbitale lroubal@med.muni.czlroubal@med.muni.cz 44 NerveNerve blockblock anaesthesiaanaesthesia N.N. alveolarisalveolaris inferiorinferior ForamenForamen mandibularemandibulare N. Alveolaris inferior N. lingualis lroubal@med.muni.czlroubal@med.muni.cz 55 NerveNerve blockblock anaesthesiaanaesthesia NervusNervus alveolarisalveolaris inferiorinferior InIn sulcussulcus collicolli mandibulaemandibulae lroubal@med.muni.czlroubal@med.muni.cz 66 NerveNerve blockblock anaesthesiaanaesthesia N.N. alveolarisalveolaris inferiorinferior IndirectIndirect DirectDirect lroubal@med.muni.czlroubal@med.muni.cz 77 NerveNerve blockblock anaesthesiaanaesthesia N.N. alveolarisalveolaris inferiorinferior IndirectIndirect PutPut thethe forefingerforefinger onon thethe occlusalocclusal surfacesurface RotateRotate insideinside ((nailnail insideinside)) 1 cm1 cm upup occlusalocclusal surfacesurface thethe puncturepuncture isis situatedsituated lroubal@med.muni.czlroubal@med.muni.cz 88 NerveNerve blockblock anaesthesiaanaesthesia N.N. alveolarisalveolaris inferiorinferior IndirectIndirect 1.1. TheThe needleneedle goesgoes behindbehind thethe cristacrista temporalistemporalis,, thethe syringesyringe onon thethe oppositeopposite caninecanine lroubal@med.muni.czlroubal@med.muni.cz 99 NerveNerve blockblock anaesthesiaanaesthesia N.N. alveolarisalveolaris inferiorinferior IndirectIndirect 2.2. TheThe needleneedle goesgoes deeperdeeper inin thethe contactcontact withwith thethe bonebone TheThe syringesyringe goesgoes mesialmesial lroubal@med.muni.czlroubal@med.muni.cz 1010 NerveNerve blockblock anaesthesiaanaesthesia N.N. alveolarisalveolaris inferiorinferior IndirectIndirect 3.3. TheThe contactcontact withwith bonebone IsIs lostlost,, thethe syringesyringe goesgoes backback lroubal@med.muni.czlroubal@med.muni.cz 1111 NerveNerve blockblock anaesthesiaanaesthesia N.N. alveolarisalveolaris inferiorinferior DirectDirect PutPut thethe forefingerforefinger onon thethe occlusalocclusal surfacesurface RotateRotate insideinside ((nailnail insideinside)) 1,5 cm1,5 cm deepdeep lroubal@med.muni.czlroubal@med.muni.cz 1212 NerveNerve blockblock anaesthesiaanaesthesia N.N. alveolarisalveolaris inferiorinferior Area: Molars Premolars Tongue lroubal@med.muni.czlroubal@med.muni.cz 1313 NerveNerve blockblock anaesthesiaanaesthesia N.N. alveolarisalveolaris inferiorinferior DirectDirect TheThe puncturepuncture atat thethe samesame placeplace TheThe syringe onsyringe on oppositeopposite premolarspremolars TheThe puncturepuncture goesgoes intointo thethe smallsmall pinkpink depressiondepression medialmedial fromfrom cristacrista temporalistemporalis andand laterallateral fromfrom plicaplica prerygomandibularisprerygomandibularis 1,5 cm1,5 cm deepdeep MolarsMolars,, premooarspremooars,, mucosamucosa, skin, bone, skin, bone lroubal@med.muni.czlroubal@med.muni.cz 1414 NerveNerve blockblock anaesthesiaanaesthesia N.N. mentalismentalis F.F. mentalementale TheThe puncturepuncture isis situatedsituated behindbehind hehe distaldistal surfacesurface ofof 2nd2nd premolarpremolar TheThe needleneedle goesgoes betweenbetween rootsroots ofof premolarspremolars lroubal@med.muni.czlroubal@med.muni.cz 1515 NerveNerve blockblock anaesthesiaanaesthesia N.N. mentalismentalis F.F. mentalementale TheThe puncturepuncture isis situatedsituated behindbehind thethe distaldistal surfacesurface ofof 2nd2nd premolarpremolar TheThe needleneedle goesgoes betweenbetween rootsroots ofof premolarspremolars,, FromFrom upup toto downdown ForwardForward andand mesialmesial PremolarsPremolars andand caninecanine,, mucosamucosa, skin., skin. lroubal@med.muni.czlroubal@med.muni.cz 1616 NerveNerve blockblock anaesthesiaanaesthesia ForamenForamen palatinumpalatinum majusmajus DistalDistal surfacesurface ofof l.l.stst molarmolar TheThe puncturepuncture isis 0,50,5 ­­ 1 cm1 cm beforebefore fromfrom behindbehind forwardforward HalfHalf ofof palatepalate lroubal@med.muni.czlroubal@med.muni.cz 1717 NerveNerve blockblock anaesthesiaanaesthesia ForamenForamen incisivumincisivum NervusNervus incisivusincisivus PapillaPapilla incisivaincisiva NextNext tutu papillapapilla,, mesialmesial directiondirection TriangularTriangular areaarea behindbehind incisorsincisors lroubal@med.muni.czlroubal@med.muni.cz 1818 NerveNerve blockblock anaesthesiaanaesthesia Raise the lip, the index finger on f. Infraorbitale (1cm below the border of the orbit) The needle from down tu up lroubal@med.muni.czlroubal@med.muni.cz 1919 SutureSuture SutureSuture materialmaterial SilkSilk,nylon,nylon NeedelsNeedels -- bentbent,, roundedrounded -- straightstraight NeedleNeedle holdersholders -- autofixautofix --withoutwithout fixationfixation lroubal@med.muni.czlroubal@med.muni.cz 2020 SutureSuture SutureSuture materialmaterial SilkSilk,nylon,nylon NeedelsNeedels -- bentbent,, roundedrounded -- straightstraight NeedleNeedle holdersholders -- autofixautofix --withoutwithout fixationfixation lroubal@med.muni.czlroubal@med.muni.cz 2121 SutureSuture SutureSuture materialmaterial SilkSilk,nylon,nylon NeedelsNeedels -- bentbent,, roundedrounded -- straightstraight NeedleNeedle holdersholders -- autofixautofix --withoutwithout fixationfixation TweerersTweerers ­­ tissuetissue forcepsforceps lroubal@med.muni.czlroubal@med.muni.cz 2222 SuturaSutura Surgical knot - single lroubal@med.muni.czlroubal@med.muni.cz 2323 SutureSuture Continuus suture lroubal@med.muni.czlroubal@med.muni.cz 2424 SutureSuture MatressMatress suturesuture lroubal@med.muni.czlroubal@med.muni.cz 2525 SutureSuture WellWell adaptedadapted bordersborders WithoutWithout tensiontension NeedleNeedle goesgoes perpendicularyperpendiculary lroubal@med.muni.czlroubal@med.muni.cz 2626 lroubal@med.muni.czlroubal@med.muni.cz 2727 lroubal@med.muni.czlroubal@med.muni.cz 2828 lroubal@med.muni.czlroubal@med.muni.cz 2929 lroubal@med.muni.czlroubal@med.muni.cz 3030 lroubal@med.muni.czlroubal@med.muni.cz 3131