Tuberal anesthesia is the most dangerous injection technique in terms of complications. 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 to block the alveolar nerves.
Features of the procedure
The complex anatomical characteristics of the injection site increase the risk of complications and reduce the effectiveness of anesthesia. Consider some points.
In the temporal-pterygoid space above the upper jaw is the venous plexus. It occupies the area from the infraorbital fissure to the lower jaw. An accidental puncture of the venous wall causes the formation of an extensive hematoma, which is difficult to prevent.
The introduction of the needle at an insufficient level leads to the fact that the injection of the solution is carried out into the subcutaneous fatty tissue. In this casetuberal anesthesia will not be effective at all. Exceeding the depth of insertion of the needle leads to the following consequences:
- Injection of an anesthetic into the area of the optic nerve causes temporary blindness.
- Injection of the drug into the fiber of the orbit causes temporary strabismus.
- Injection of the solution into the pterygoid muscle causes severe pain after the effect of the anesthetic wears off.
The tip must not be allowed to slide over the tubercle during the procedure, as perforation of nerves and small vessels is possible.
Anesthesia area
Tuberal anesthesia in dentistry allows you to anesthetize the following areas:
- area of upper molars;
- periosteum and the mucous membrane of the alveolar process covering it;
- mucosa and bone of the maxillary sinus along the posterior wall.
The boundary area of anesthesia passing from behind is constant. In front, it can reach the middle of the first small molar and, accordingly, the mucous membrane located in this area along the gum.
Egorov intraoral tuberal anesthesia
Procedure:
- The patient's mouth is half open. The cheek is adhered with a spatula.
- Having directed the cut of the needle towards the bone tissue, the doctor makes a puncture at the level of the second molar to the bone.
- The needle should be at an angle of 45o to the alveolar process.
- The needle moves up, back and to the middle,at the same time, it is necessary to control its constant contact with the bone. A small amount of anesthetic is released along the way.
- The needle is inserted 2-2.5 cm. The piston is pulled back to check that the vessel has not been punctured.
- If there is no blood, up to 2 ml of solution is injected. The syringe is removed.
- The patient presses the anesthesia site to avoid hematoma.
- The full effect of the drug appears within 10 minutes.
If you use a short-acting anesthetic, the procedure will be effective for 45 minutes, if long - up to 2.5 hours. Intraoral tuberal anesthesia is performed for outpatient operations and for simultaneous intervention on several molars.
Extraoral method
Regardless of which side tuberal anesthesia is needed, the technique of administration requires tilting the patient's head in the opposite direction. Before anesthesia itself, the doctor determines the depth to which the needle will need to be inserted. This is the distance between the inferior outer corner of the orbit and the anterior inferior angle of the zygoma.
The dentist is positioned to the right of the patient. The needle is inserted in the area of the anteroinferior angle of the zygomatic bone. It should have an angle of 45o with respect to the median sagittal plane and a right angle to the trago-orbital line. After inserting the needle to the desired depth, an anesthetic is injected. Pain relief develops over 5 minutes.
Drugs
Tuberal anesthesia is performed using local anesthetics:
- Lidocaine - is the first derivative of amides, on the basis of which "Bupivacaine", "Articaine", "Mesocaine" and other drugs were synthesized. It is used in the form of a 1-2% solution. Lidocaine belongs to the drugs of a low price category. Contraindicated in patients with organic liver damage.
- Trimecaine is a derivative of amides. In terms of its effectiveness, speed and duration of action, it surpasses novocaine several times. Available in the form of solutions of various concentrations. As a side effect of the introduction of the drug, pallor of the skin, nausea, headache may occur.
- The drug "Ultracain", the price of which 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 diffusion capacity and good duration of action make it possible to use it not only in surgical, but also in orthopedic dentistry. How much does Ultracain cost? The price of the drug (for anesthesia with this particular agent 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 products are used in combination with a vasoconstrictor (adrenaline). When choosing a drug, the specialist determines the individual tolerance and the maximum dose,takes into account the patient's age, as well as the presence of pregnancy and concomitant pathologies.
Complications of the procedure
Tuberal anesthesia, reviews of which are mixed (patients note an excellent analgesic effect, but some complain that the numbness does not go away for a long time, up to 5 hours, plus the side effects already mentioned above are not to the liking of many), should be carried out by a highly qualified specialist who is able to take into account all the necessary nuances of the event. Some of the possible complications have already been considered. Time should be devoted to the issue of their prevention.
Injury to blood vessels and the formation of hematomas in the area of anesthesia can be prevented. For this purpose, during anesthesia, the contact of the needle with the bone tissue should not be lost and it should not be inserted more than 2.5 cm. After the needle is removed, the infiltrate formed by the injected anesthetic is massaged upwards behind the maxillary tubercle. Tuberal 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 increases 10 times, and the effect of the vasoconstrictor - 40 times. The patient may experience shock, collapse, fainting. To prevent such a complication, before injecting the anesthetic, the syringe plunger is pulled back. This allows you 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.
Violation of asepsis rules during the procedure maylead to infection. Inserting the needle into the 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
Due to the large number of complications and the complexity of the technique, tuberal anesthesia is rarely practiced. The choice of anesthesia should be entrusted to a specialist.
