Torusal anesthesia, or anesthesia according to Weisbrem, acts on the entire area of the lower jaw, including mucous membranes, teeth, skin of the cheeks, chin area and alveolar process. The difference between this method and the traditional one is that the doctor inserts the needle straight, without any change in inclination. Torusal anesthesia is a modified mandibular anesthesia.
Indications for such a procedure
Torusal anesthesia method is used in such cases:
- painful dental treatment in the dental chair (from caries or tooth extraction in the lower jaw);
- Gummatic application period for jaw trauma;
- removal of malformed teeth;
- surgical intervention to remove cysts, as well as other tumors in the lower jaw (such an event is also performed under local anesthesia);
- pulling out a fully grown tooth stuck in the bone;
- opening abscesses (purulent formations), however, in such a situation, several types of anesthesia should be combined;
- cutting the hood of the wisdom tooth on the lower jaw.
Need to Know
For correctthe implementation of anesthesia, you need to see the topography of the mandibular opening, which is located on the hidden surface of the jaw fork (from the facial region of the jaw process in the interval of 15 mm, 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, and in children and the elderly it is slightly lower.
In front, the slot is protected by a bony protrusion, the so-called uvula of the mandibular zone. Therefore, in order to make it more convenient to carry out torusal anesthesia, an injection is made in a place 0.7-1 cm above the level of the opening, that is, above the superficial point of the tongue of the lower jaw. At this point, the process of the nerve is placed in the bony groove, where there is a porous tissue that allows the drug to spread freely.
What are the goals of mandibular anesthesia
Conductive anesthesia on the lower jaw according to Weisbrem is often also called torusal. Unlike a typical technique, the task of this method is to achieve the mandibular elevation, which is based on a bone neoplasm - the connection of the tissues of the condylar and coronal sprouts. It is located on the closed outer part of the lower jaw closer to the bony tongue. Such a lumen is made of fiber, in which the buccal, mandibular and lingual nerve trunks are connected. Mandibular anesthesia is performed intraorally and extraorally. With intraoral access, two methods of such anesthesia are used: palpation and apodactyl (without probing).
Palpatory method
Anesthesia by palpation. To perform it, you need to find out by palpation the location of the temporal crest (this is a guideline for puncture with a needle) and the retromolar recess. The temporal crest is a bony cushion that runs from the coronoid to the lingual wall of the alveolar zone of the mandible. In the inner part, this scallop is divided into open and closed rods. They form a small area - the retromolar triangle.
Such anatomical neoplasm must be distinguished from the retromolar fossa, which is located between the temporal crest and the facial region of the lower jaw. It follows from this that the retromolar recess is located on the side of the triangle. If torusal anesthesia is performed on the right, then the bone landmarks are palpated with the index finger of the left hand, if on the left - with the thumb of the same hand.
Torusal anesthesia technique
- The patient is told to open his mouth to the maximum and the anterior edge of the process of the lower jaw is felt at the level of the distal line of the crown of the third molar (if it is absent, then behind the second molar).
- Moving the finger a little to the inside, the doctor finds the temporal crest, then sets the finger in the retromolar recess, which is narrowed by these anatomical formations.
- Fixing the syringe on the surface of the premolars on the other hand, the specialist injects with a needle near the temporal crest 0.8-1 cm above the chewing level of the third molar, then advances the needleto the outside and inside.
- Now the technique of torusal anesthesia goes like this: the needle reaches the bone at a depth of about 0.5-0.7 cm, in this area a small dose of medication is injected to anesthetize the lingual nerve, located in front of the lower alveolar nerve.
- Then the syringe goes to the area of the incisors, and the needle moves higher, that is, parallel to the closed outer part of the process 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 drugs of the amide group "Ultracain D-S Forte", the dose of the injected agent is approximately 2 ml.
Apodactyl technique
The pterygo-mandibular fold, which is well detected, is considered to be the main reference point when performing this method. It can be narrow, wide or medium width, located to the inside of the temporal crest.
How the procedure works
Torusal anesthesia in dentistry is performed as follows:
- The dentist tells the patient to open his mouth wide, then fixes the syringe at the level of the lower jaw.
- The needle is injected into the outer slope of the pterygo-mandibular fold in the center between the chewing planes of the lower and upper molars (if they are absent, then in the middle of the distance between the crests of the alveolar region and the sprout).
- Next, the specialist advances the needle to the outer and inner side of the fold until it connects withbone tissue to a depth of 1.5-2 cm, as a result of which he injects a medicine to anesthetize the lingual and inferior alveolar nerves. The pterygomandibular fold is less accurate than the temporal crest.
Extraoral access
Torusal anesthesia of the lower jaw is carried out in this way, if, for example, there are difficulties with opening the mouth. How the event is produced:
- The projection of the mandibular incision on the skin is determined. Such a hole is placed in the center of the strip running from the superficial margin of the tragus of the auricle to the zone of intersection of the facial features of the masticatory muscle.
- A needle injection is made at the base of the jaw 1.5 cm to the front edge from its corner.
- Then the needle moves a little higher by 3-4 cm along the closed surface of the process of the mandibular opening parallel to its back side. While passing the needle, keep its contact with the bone.
- Anesthetic is injected at the end. Then, moving the needle up another 1 cm, the remaining pain medication is poured in, turning off the nerve of the tongue.
Anesthetic site
Torusal anesthesia is primarily carried out in order to anesthetize several zones in the oral cavity at once, namely:
- lingual and inferior alveolar nerve;
- skin of the chin at the site of anesthesia;
- all teeth of the mandibular half;
- mucosa and skin of the lowerlips;
- bone tissue of the alveolar side and parts of the body of the lower jaw;
- mucous membrane of the sublingual zone and 2/3 of the anterior part of the tongue;
- mucous wall of the alveolar point from the lingual and vestibular edges.
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: an additional 0.5 ml of medication is injected into the intermediate fold, similar to 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 zone of incisors and canines is much lower due to anastomoses from the opposite side. With this anesthesia, drugs such as Novocain, Trimecaine, Ultracaine or Lidocaine are used.
Complications
Torusal anesthesia can also bring harm, namely:
- hematoma formation;
- fractured injection needle;
- numbness of the tissues of the pharynx;
- neuritis of the inferior lingual and alveolar nerve;
- damage to the hidden pterygoid muscle with further formation of contracture of the lower jaw.
The above complications appear when the technique of performing anesthesia is violated. Thus, torusal anesthesia is not an easy procedure and requires highly qualified dentist.
