Thoracic anesthesia in dentistry: technique of carrying out, anesthesia zone

Thorassal anesthesia, or Weisbrem anesthesia, affects 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 with jaw trauma;
• Removal of wrongly formed teeth;
• Surgical intervention for the removal of cysts, as well as other tumors on the lower jaw (this measure is also performed under local anesthesia);
• Tearing out a fully grown tooth stuck in the bone;
• Opening of abscesses (purulent formations), however in this 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, you need to see the topography of the mandibular opening, which is located on the hidden surface of the jaw branch (from the facial region of the jaw bone 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 slit is protected by a bone protrusion, the so-called 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, over 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 distributed.

What are the goals of mandibular anesthesia

Conducting anesthesia on the lower jaw by Weisbrem 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 neoplasm - the union of the condyle and coronary sprouts. It is located on the closed external part of the lower jaw nearer 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 intra-oral 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 perform it, you need to find out the location of the temporal ridge (this is the reference point for the needle puncture) and the posterolar groove by the method of feeling. 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 area - the backmolar triangle.

This anatomical neoplasm should be distinguished from the posterolar fossa, which lies between the temporal ridge and the facial area 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 bones are probed with the index finger of the left hand, if left - with the thumb of the same hand.

Torus anesthesia: technique

1. The patient is told to open his mouth to the maximum and feel the anterior edge 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).
2. Moving the finger a little to the inside, the doctor finds the temporal scallop, then sets the finger in the posteroluminal recess, which is narrowed by these anatomical formations.
3. Fixing the syringe on the surface of the premolars on the other side, 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.
4. Now the technique of thoracic anesthesia goes like this: the needle reaches the bone at a depth somewhere between 0.5 and 0.7 cm, in this zone a small dose of medication is administered to anaesthetize the lingual nerve located in front of the lower alveolar nerve.
5. Then the syringe moves to the site of the incisors, and the needle moves 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 "Ultracaine DS Forte", the dose of the injected agent is approximately 2 ml.

Apodactyl technique

The main reference point for performing this method is the pterygo-mandibular fold, which is well detected. It can be narrow, wide or of medium width, located to the inside of the temporal scallop.

How is the procedure performed

Torus anesthesia in dentistry is carried out as follows:

1. The dentist tells the patient to open his mouth wide, then fixes the syringe at the level of the lower jaw.
2. The needle prick is applied to the outer slope of the pterygo-mandibular fold to the center between the chewing planes of the lower and upper molars (if they are absent - then midway between the crests of the alveolar region and the sprout).
3. Further, the specialist moves the needle to the outer and inner sides 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 carried out in this way, if, for example, there are difficulties with opening the mouth. How the event is produced:

1. The projection of the mandibular slit on the skin is determined. Such an opening 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 masticatory muscle.
2. A needle prick is made at the base of the jaw by 1.5 cm to the front edge from its angle.
3. Then the needle moves slightly higher by 3-4 cm along the closed surface of the appendage of the mandibular opening parallel to its back side. At the time of passage of the needle, it is necessary to hold its contact with the bone.
4. At the end, an anesthetic is injected. 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 mucous chamber of the alveolar region 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.

The anesthetic result with such anesthesia begins 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 Novocain, Trimecaine, Ultrakain, or Lidocaine are used.

Complications

Anasthesia of the thoracic can also bring harm, namely:

• Formation of a hematoma;
• Fracture of the injection needle;
• Numbness of the pharynx tissues;
• Neuritis of the lingual and alveolar nerve;
• Damage to the hidden pterygoid muscle with further formation of the lower jaw contracture.

The abovementioned complications occur when the technique of anesthesia is violated. Thus, carrying out thoracic anesthesia - the procedure is not simple and requires a high qualification of the dentist.