ORAL AND MAXILLOFACIAL SURGERY II. ANAESTHESIA SUTURE PAIN CONTROL - INDICATIONS OF ANAESTHESIA • Surgical treatment • Preparation of cavities • Preparation for crowns • Endodontic treatment CLASSIFICATION • General anaesthesia • Analgesia (inhalation, sedation) • Hypnosis • Local anaesthesia DRUGS • Articain 4% with epinephrine 1: 200 000 • Articain 4% with epinephrin 1:100 000 • Mepivacain 3%plain • Prilocaine 4% with epinephrine 1:200 000 • Prilocaine plain • Lidocain spray 10% • Xylocain spray 10% BENEFITS OF LOCAL ANAESTHESIA • Comfort for the patient • Haemostasis (addtion of epinephrin – hormone of suprarenal gland – arteficial) • Operator efficiency LOCAL ANAESTHESIA • Topical (spray,liquid) applied on mucosa • By injection - Infiltration - Nerve block - PDL –periodontal ligament anaesthesia - Intrapulpal anaesthesia LOCAL ANAESTHESIA CONTRAINDICATIONS • Allergy • Serious systemic diseases (blood circulation) • Antithrombotic therapy , coagulopathy – nerve blocked anaesthesia TOPICAL ANAESTHESIA (ON MUCOSA OR SKIN) • Liquid • Spray • Creme, paste Only nerve endings are affected For extraction of primary teth (when roots are completely resorbed) Anesethesia of the puncture will be INFILTRATION • The drug is delivered by infiltration of soft tissues using syringe and needle. INFILTRATION ANAESTHESIA • Suitable for - indications - simple extractions in maxilla, - extractions of mandibular incisors, canines - soft tissue surgery INFILTRATION • Syringe with short needle • Raise lip or cheek The puncture is situated into mucosa appr. 1cm from fornix vestibuli. Do not touch periosteum. NERVE BLOCK ANAESTHESIA Syringe with long needle  Foramen mandibulare  Foramen mentale  Foramen palatinum majus  Foramen incisivum  Foramen infraorbitale NERVE BLOCK ANAESTHESIA N. alveolaris inferior Foramen mandibulare N. Alveolaris inferior N. lingualis NERVE BLOCK ANAESTHESIA Nervus alveolaris inferior In sulcus colli mandibulae NERVE BLOCK ANAESTHESIA N. alveolaris inferior Indirect Direct NERVE BLOCK ANAESTHESIA N. alveolaris inferior Indirect Put the forefinger on the occlusal surface Rotate inside (nail inside) 1 cm up occlusal surface the puncture is situated NERVE BLOCK ANAESTHESIA N. alveolaris inferior Indirect The syringe on the opposite canine The needle goes behind the crista temporalis, NERVE BLOCK ANAESTHESIA N. alveolaris inferior Indirect The needle goes deeper in the contact with the bone The syringe goes mesial NERVE BLOCK ANAESTHESIA N. alveolaris inferior Indirect 3. The contact with bone is lost, the syringe goes back Aspiration and a injection of the drug. NERVE BLOCK ANAESTHESIA N. alveolaris inferior Direct Put the forefinger on the occlusal surface Rotate inside (nail inside) 1,5 cm deep NERVE BLOCK ANAESTHESIA N. alveolaris inferior Direct The syringe on opposite Premolars (laterally of plica ptërygomandibularis, medially of crista temporalis) 1,5 cm deep NERVE BLOCK ANAESTHESIA N. alveolaris inferior Direct  The puncture at the same place  The syringe on opposite premolars  The puncture goes into the small pink depression medial from crista temporalis and lateral from plica prerygomandibularis 1,5 cm deep NERVE BLOCK ANAESTHESIA N. alveolaris inferior Anaesthetic zone Molars, premolars, mucosa, skin, bone, tongue NERVE BLOCK ANAESTHESIA N. mentalis F. mentale The puncture is situated behind the distal surface of 2nd premolar The needle goes between roots of premolars from up to down, Forward and mesially Anaesthetic zone: Premolars and canine, mucosa, skin. NERVE BLOCK ANAESTHESIA Foramen palatinum majus – nervus palatinum majus Distal surface of second molar The puncture is 0,5 – 1 cm before from behind forward Anaesthetic zone: Half of palate NERVE BLOCK ANAESTHESIA Foramen incisivum – n. nasopalatinus Nervus incisivus Papilla incisiva Next tu papilla, mesial direction Triangular area behind incisors ANAESTHESIA ON F. INFRAORBITALE • Find the margo infraorbitalis • Raise the lip • The puncture is sitruated between canine and 1st premolar • The needle goes to the region (appr 1 cm below margo infraorbitalis) Anaesthetic zone: Canine and premolars ANAESTHESIA ON TUBER MAXILLAE • The durg si delivered on tuber maxillae • The puncture is situated behind 2nd molar (distal surface), goes behind and upper around tuber maxillae. Anaesthetic zone: Upper molars PDL ANAESTHESIA • Intraligamentary • Special syringe (pen or gun) The needle is introduced into periodontal space – few drops on anaesthetic • Indication: single extraction, preparation, pulp exstirpation Special gun Anaesthetic Needle The puncture is between gingiva and tooth and goes into gingival sulcus ANAESTHESIA - COMPLICATIONS • Bleeding • Breakage of needle • Heamatoma • Allergy (swelling, collaps) • Patient´s history is necessary!!!! INTRAPULPAL ANAESTHESIA • Exstirpation of the pulp – additional step. Directly into the pulp chamber SUTURE Suture material Silk,nylon Needels - bent, rounded - straight Needle holders - autofix -without fixation SUTURE Suture material Silk,nylon Needels - bent, rounded - straight Needle holders - autofix -without fixation SUTURE Tweezers – tissue forceps The puncture is situated appr. 2 mm from the border of the wound In the same depth - opposite The knot is out of the wound Single suture Coninuing suture Mattress suture Cross mattress suture