Tubal anesthesia in dentistry: technique, preparations

Tubal anesthesia is the most dangerous, in terms of complications, injection equipment. At the moment, this 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 the blockade of the lunar nerves.

Features of the procedure

Complex anatomical characteristics of the zone of drug administration increase the risk of complications and reduce the effectiveness of anesthesia. Let's consider some moments.

In the temporo-pterygoid space above the upper jaw is a venous plexus. It occupies the area from the lower incision to the lower jaw. The accidental puncture of the venous wall causes the formation of an extensive hematoma, which is difficult to prevent.

Introduction of the needle to an insufficient level leads to the fact that injection of the solution is carried out in the subcutaneous fatty tissue. In this case, tuberial anesthesia will not be effective at all. Exceeding the depth of needle insertion leads to the following consequences:

1. The introduction of an anesthetic into the optic nerve zone causes temporary blindness.
2. Injection of the drug into the cellulose of the orbit causes temporary strabismus.
3. The solution entering the pterygoid muscle causes a strong pain syndrome after the action of the anesthetic is over.

You can not allow the tip to slide over the mound during the procedure, since it is possible to perforate nerves and small vessels.

Zone of anesthesia

Tubal anesthesia in dentistry allows anesthetizing the following areas:

• Area of upper molars;
• Periosteum and covering the mucosa of the alveolar process ;
• The mucosa and the bone of the maxillary sinus along the posterior-walled wall.

The border area of anesthesia that passes behind is constant. From the front, it can reach the middle of the first small molar and, accordingly, the mucosa located in this area along the gum.

Intraoral tuberial anesthesia according to Yegorov

Procedure:

1. The patient's mouth is in a semi-open state. The cheek is held by a spatula.
2. By directing the cut of the needle towards the bone tissue, the doctor makes a puncture at the level of the second molar to the bone.
3. The needle should be located at an angle of 45 ° to the alveolar process.
4. The needle moves up, back and to the middle, while it is necessary to control its constant contact with the bone. In the process, a small amount of anesthetic is produced.
5. The needle is introduced to 2-2.5 cm. The piston is pulled back to check the absence of the puncture of the vessel.
6. If there is no blood, inject up to 2 ml of the solution. The syringe is removed.
7. The patient presses the place of anesthesia to avoid the appearance of a hematoma.
8. The full effect of the drug is evident for 10 minutes.

If a short-acting anesthetic is used, the procedure will be effective for 45 minutes, if prolonged - up to 2.5 hours. Intraoral tuberial anesthesia is performed for outpatient operations and with simultaneous intervention on several molars.

Extraoral method of conducting

Regardless of the direction in which tuberial anesthesia is required, the technique of carrying out requires the patient's head to be deflected in the opposite direction. Before the anesthesia, 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. The needle is inserted in the zone of the anterior margin of the malar bone. It should have an angle of 45 ° with respect to the median sagital plane and a right angle to the trago- orbital line. After inserting the needle to the desired depth, an anesthetic is injected. Anesthesia develops for 5 minutes.

Preparations

Tubal anesthesia is performed with local anesthetics:

1. Lidocaine is the first amide derivative on the basis of which "Bupivacaine", "Artikain", "Mesocaine" and other agents were synthesized. It is used as a 1-2% solution. Lidocaine is a low-price drug. Contraindicated in patients with organic lesions of the liver.
2. Trimekain is an amide derivative. By its effectiveness, speed and duration of action, Novocaine is several times more effective. It is available in the form of solutions of various concentrations. As a side effect of the introduction of the remedy, skin pallor, nausea, headache may occur.
3. The drug "Ultrakain", whose price 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 diffusivity and good duration of action allow using it not only in surgical, but also in orthopedic dentistry. How much does "Ultracaine" cost? The price of the drug (for anesthesia, this means in dental clinics in Russia will have to pay from 250 to 300 rubles) is explained by its foreign origin. Analogues - "Artikain", "Alfakain", "Ubistezin".

All funds are used in combination with a vasoconstrictor (adrenaline). When choosing a drug specialist determines the individual tolerability and the maximum dose, takes into account the age of the patient, as well as the presence of pregnancy and accompanying pathologies.

Complications of the procedure

Tuberial anesthesia, whose reviews are mixed (patients note an excellent analgesic effect, but some complain that numbness does not last long, up to 5 hours, plus the side-effects already mentioned above do not like many), should be conducted 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 given to the issue of their prevention.

The wounding of blood vessels and the formation of hematomas in the field of anesthesia can be prevented. For this purpose, during anesthesia, you can not lose contact between the needle and bone tissue and inject it no more than 2.5 cm. After removing the needle, the infiltrate formed by the injected anesthetic is massaged upwards beyond the maxillary tuber. Tubal anesthesia is allowed only in the absence of inflammatory processes at the injection site.

Dangerous for the patient is getting the solution into the bloodstream. Its toxicity is increased by 10 times, and the action of the vasoconstrictor is 40. The patient may experience shock, collapse, fainting. To prevent this complication, before injecting the anesthetic, the syringe piston is pulled back. This makes it possible to make 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.

Violating the rules of asepsis during the procedure can lead to infection. Inserting the needle into your mouth, you need to make sure that it does not touch the tooth. The ingress of plaque will lead to the development of phlegmon.

Conclusion

In connection with a large number of complications and with the complexity of the technique of conducting tuberous anesthesia, it is rarely practiced. The choice of anesthesia should be entrusted to a specialist.