Deck 14: Injections for Mandibular Pain Control

Question 1

Match the following:

-Akinosi (VA) nerve block

A) Medial border of retromolar triangle
B) Mental nerve block target
C) Anterior border of ramus
D) IA target
E) Persistent anesthesia
F) True mandibular block
G) Requires post-injection pressure
H) Bony obstruction
I) Muscle soreness
J) Closed mouth technique

Answer 1

Closed mouth technique

Question 2

Match the following:

-Coronoid notch

A) Medial border of retromolar triangle
B) Mental nerve block target
C) Anterior border of ramus
D) IA target
E) Persistent anesthesia
F) True mandibular block
G) Requires post-injection pressure
H) Bony obstruction
I) Muscle soreness
J) Closed mouth technique

Answer 2

Anterior border of ramus

Question 3

Match the following:

-Gow-Gates nerve block

A) Medial border of retromolar triangle
B) Mental nerve block target
C) Anterior border of ramus
D) IA target
E) Persistent anesthesia
F) True mandibular block
G) Requires post-injection pressure
H) Bony obstruction
I) Muscle soreness
J) Closed mouth technique

Answer 3

True mandibular block

Question 4

Match the following:

-Incisive foramen

A) Medial border of retromolar triangle
B) Mental nerve block target
C) Anterior border of ramus
D) IA target
E) Persistent anesthesia
F) True mandibular block
G) Requires post-injection pressure
H) Bony obstruction
I) Muscle soreness
J) Closed mouth technique

Question 5

Match the following:

-Incisive nerve block

A) Medial border of retromolar triangle
B) Mental nerve block target
C) Anterior border of ramus
D) IA target
E) Persistent anesthesia
F) True mandibular block
G) Requires post-injection pressure
H) Bony obstruction
I) Muscle soreness
J) Closed mouth technique

Question 6

Match the following:

-Internal oblique ridge

A) Medial border of retromolar triangle
B) Mental nerve block target
C) Anterior border of ramus
D) IA target
E) Persistent anesthesia
F) True mandibular block
G) Requires post-injection pressure
H) Bony obstruction
I) Muscle soreness
J) Closed mouth technique

Question 7

Match the following:

-Mandibular foramen

A) Medial border of retromolar triangle
B) Mental nerve block target
C) Anterior border of ramus
D) IA target
E) Persistent anesthesia
F) True mandibular block
G) Requires post-injection pressure
H) Bony obstruction
I) Muscle soreness
J) Closed mouth technique

Question 8

Match the following:

-Paresthesia

A) Medial border of retromolar triangle
B) Mental nerve block target
C) Anterior border of ramus
D) IA target
E) Persistent anesthesia
F) True mandibular block
G) Requires post-injection pressure
H) Bony obstruction
I) Muscle soreness
J) Closed mouth technique

Question 9

Match the following:

-Premature contact

A) Medial border of retromolar triangle
B) Mental nerve block target
C) Anterior border of ramus
D) IA target
E) Persistent anesthesia
F) True mandibular block
G) Requires post-injection pressure
H) Bony obstruction
I) Muscle soreness
J) Closed mouth technique

Question 10

Match the following:

-Trismus

A) Medial border of retromolar triangle
B) Mental nerve block target
C) Anterior border of ramus
D) IA target
E) Persistent anesthesia
F) True mandibular block
G) Requires post-injection pressure
H) Bony obstruction
I) Muscle soreness
J) Closed mouth technique

Question 11

The inferior alveolar nerve is the largest branch of the anterior division of the mandibular nerve.

Question 12

The IA nerve traverses lateral to the sphenomandibular ligament.

Question 13

The IA artery branches from the maxillary artery and descends through the pterygomandibular space.

Question 14

The three key landmarks for the IA nerve block are the pterygomandibular raphe, the coronoid notch, and the external oblique ridge.

Question 15

The deposition site for an IA nerve block is superior to the mandibular foramen on the medial surface of the ramus.

Question 16

The IA injection has a 10 to 15% positive aspiration rate.

Question 17

The lingual nerve is usually anesthetized along with the IA nerve when an IA nerve block is administered.

Question 18

The buccal nerve is anesthetized by an IA nerve block.

Question 19

Profound anesthesia of the incisive and mental nerves is achieved by a mental nerve block.

Question 20

The Gow-Gates nerve block will achieve buccal and lingual anesthesia.

Question 21

A ________ needle is recommended for an inferior alveolar nerve block.

Question 22

The penetration site for an inferior alveolar nerve block is slightly ________ to the pterygomandibular raphe.

Question 23

The largest branch of the mandibular division of the trigeminal nerve is the ________.

Question 24

A minimum of ________ mL of anesthetic solution is required for an inferior alveolar nerve block due to the large diameter of the nerve.

Question 25

The lingual nerve is usually located ________ to the inferior alveolar nerve.

Question 26

The buccal nerve crosses the coronoid notch of the ramus at the level of the ________.

Question 27

The deposition site for a buccal nerve block is at the buccal aspect of the ramus, lateral to the ________ as the nerve passes over the anterior border of the ramus.

Question 28

The mental nerve typically exits the mandible between the ________.

Question 29

The depth of insertion for a mental nerve block is typically ________ mm.

Question 30

A typical minimum recommended volume of anesthetic solution for a mental nerve block is ________ mL.

Question 31

The field of anesthesia for an incisive nerve block includes the buccal mucous membrane and skin of the lower lip and chin, and the ________ anterior to the mental foramen, to the midline.

Question 32

Following the deposition of anesthetic solution for an incisive nerve block, ________ is applied directly and steadily over the mental foramen.

Question 33

A ________ nerve block anesthetizes an entire mandibular quadrant.

Question 34

The deposition site for a Gow-Gates nerve block is often ________ mm from the inferior alveolar nerve.

Question 35

Deposit a recommended minimum of ________ mL of anesthetic solution for a Gow-Gates nerve block.

Question 36

Crucial to the success of Gow-Gates nerve blocks, patients must remain in a ________ position throughout the procedure for up to 2 minutes following deposition of anesthetic solution.

Question 37

The needle pathway is ________ to the posterior segment of the maxillary occlusal plane during a Vazirani-Akinosi nerve block.

Question 38

Deposit a minimum of ________ mL of anesthetic solution for a Vazirani-Akinosi nerve block.

Question 39

A Vazirani-Akinosi nerve block is also called the ________ technique.

Question 40

Prolonged anesthesia following local anesthetic procedures is called ________.

Question 41

Which of the following vessels is not located within the infratemporal and pterygomandibular spaces?

A) Maxillary artery and vein
B) Middle meningeal artery and vein
C) Inferior alveolar artery and vein
D) Facial artery and vein

Question 42

Which teeth and soft tissues are innervated by the inferior alveolar nerve?

A) Mandibular molars and premolars, and buccal gingiva
B) Mandibular teeth from the premolars to the incisors and buccal soft tissues
C) Mandibular teeth to the midline and the buccal soft tissues
D) Mandibular teeth to the midline and buccal soft tissue from premolars to the midline

Question 43

Which of the following reasons best describes why it is advantageous to use a 25 gauge long needle for an IA nerve block?

A) Greater depth of penetration, less needle flexibility when contacting bone to determine deposition site, high risk of positive aspiration
B) Ease of penetration through fibrous submucusal tissues, greater depth of penetration, low risk of positive aspiration
C) Greater depth of penetration, greater accuracy of aspiration outcomes, less needle deflection
D) Comfort level during penetration, greater depth of penetration, low risk of negative aspiration

Question 44

Which of the following best describes the correct syringe position for an IA nerve block?

A) Over the canine on the contralateral side of the mouth above the occlusal plane
B) Over the premolars on the contralateral side of the mouth angled 45 degrees from the occlusal plane
C) Over the premolars on the contralateral side of the mouth above and parallel to the occlusal plane
D) At the labial commissure over the molars on the contralateral side of the mouth

Question 45

Which of the following is not a helpful landmark to identify the penetration site for an inferior alveolar nerve block?

A) Mandibular occlusal plane
B) Pterygomandibular raphe
C) Maxillary occlusal plane
D) Internal oblique ridge

Question 46

Which of the following correctly describes the needle pathway for an IA nerve block?

A) Lateral to the pterygomandibular raphe, into the pterygomandibular space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen
B) Lateral to the pterygomandibular raphe, into the pterygomandibular space; passing medial to the medial pterygoid muscle; posterior and medial to the lingual nerve, lateral to the sphenomandibular ligament; and superior to the lingula and mandibular foramen
C) Medial to the pterygomandibular raphe, into the infratemporal space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen
D) Medial to the pterygomandibular raphe, into the pterygomandibular space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen

Question 47

Which of the following statements best describes the technique error(s) that results in premature contact with bone immediately after penetration for an IA nerve block?

A) Penetration too high and too lateral to pterygomandibular raphe
B) Penetration too low and too lateral to pterygomandibular raphe
C) Penetration too medial to the internal oblique ridge in relationship to the pterygomandibular raphe
D) Angle of the syringe was anterior to the premolars

Question 48

Which anatomical structure should be medial to the needle at the IA deposition site?

A) Pterygomandibular raphe
B) Hylomandibular ligament
C) Stylomandibular ligament
D) Spenomandibular ligament

Question 49

What is the recommended volume of local anesthetic solution for an inferior alveolar nerve block for an adult?

A) 0.6 to 1.0 mL
B) 0.9 to 1.5 mL
C) 1.2 mL
D) 1.5 to 1.8 mL

Question 50

The typical rate of positive aspiration for an IA nerve block is:

A) 5% to 15%
B) 10% to 15%
C) 10% to 20%
D) 15% to 25%

Question 51

What is the most probable IA nerve block penetration error when immediate premature contact is made with bone?

A) Too low and/or too lateral to the pterygomandibular raphe
B) Too low and/or too medial to the pterygomandibular raphe
C) Too high and/or too lateral to the sphenomandibular ligament
D) Too low and/or too medial to the sphenomandibular ligament

Question 52

What is the best correction to make during an IA injection when premature bony contact is met immediately after penetration?

A) Reposition syringe toward the mandibular incisors
B) Reposition syringe toward the contralateral canine
C) Reposition syringe toward the first molar
D) Withdraw the syringe

Question 53

What is the best correction to make during an IA injection when premature bony contact is met at less than one half of the penetration depth?

A) Reposition syringe toward the contralateral canine and re-advance the needle until bony contact is met.
B) Partially withdraw the needle, reposition syringe over the contralateral canine and re-advance the needle until bony contact is met.
C) Partially withdraw the needle, reposition syringe over the contralateral canine, advance needle to clear resistance, then reposition the syringe over the premolars, and re-advance the needle until bony contact is met.
D) Withdraw the syringe to minimize tissue trauma and reinject.

Question 54

What is the best correction to make during an IA injection when no bony contact is met at target depth?

A) Reposition the syringe over the contralateral canine and re-advance the needle until bony contact is met.
B) Withdraw the needle at least half way, reposition the syringe over the molars, re-advance the needle until bone is met.
C) Aspirate in two plane to assure negative aspiration and inject 1.8 mL.
D) Withdraw the needle and select an alternate technique.

Question 55

Which of the following is a possible complication of an IA nerve block when penetration is too deep?

A) Piercing the parotid gland and numbing the hypoglossal nerve
B) Piercing a vessel in the pterygoid plexus increasing potential of hematoma
C) Piercing the parotid gland and numbing the facial nerve
D) Piercing the external carotid artery causing a severe hematoma

Question 56

Which of the following injections is not an alternate for an unsuccessful anesthesia of a mandibular first molar?

A) Incisive nerve block
B) Akinosi nerve block
C) Gow-Gates nerve block
D) Periodontal ligament injection

Question 57

What is the position of the lingual nerve in relation to the inferior alveolar nerve?

A) Anterior and lateral
B) Inferior and lateral
C) Anterior and medial
D) Posterior and medial

Question 58

What is minimum recommended volume of anesthetic solution administered for a lingual nerve block?

A) 0.2 mL
B) 0.6 mL
C) 0.9 mL
D) 1.5 mL

Question 59

Which of the following nerve block injections is safest when avoiding the risk of lingual nerve injury when a procedure requires lingual anesthesia?

A) Incisive
B) Inferior alveolar
C) Vazirani-Akinosi
D) Gow-Gates

Question 60

Which of the following correctly describes the buccal nerve pathway?

A) Crosses the coronoid notch and innervates the medial pterygoid and buccinator muscles
B) Crosses the coronoid notch at the level of the mandibular occlusal plane
C) Crosses at the height of the coronoid notch and divides into several branches that innervate the buccal mucosa and gingival
D) Divides into several branches and crosses the coronoid notch and innervates the buccinators muscle, mucosa and gingiva of the mandibular molars

Question 61

Which of the following describes the field of anesthesia for the buccal nerve block?

A) Facial mucosa, gingiva and pulps of mandibular molars
B) Facial and lingual mucosa and gingiva of mandibular molars
C) Facial soft tissue and periodontium of mandibular molars
D) Facial soft tissue and periodontium of mandibular molars to the midline

Question 62

What is the insertion depth for a buccal nerve block?

A) 2 mm
B) 3 to 4 mm
C) 6 mm
D) 4 to 8 mm

Question 63

What is minimum recommended volume of anesthetic solution administered for a buccal nerve block?

A) 0.2 to 0.3 mL
B) 0.6 mL
C) 0.9 mL
D) 1.0 to 1.5 mL

Question 64

Which of the following procedures would not require a buccal nerve block?

A) Periodontal surgical procedure for teeth 27 to 29
B) Placement of a rubber dam on 31
C) Root planning of teeth 18 to 20
D) Crown preparation of tooth 30

Question 65

The mental nerve is a terminal branch of the

A) Cervical nerve
B) Inferior alveolar nerve
C) Incisive nerve
D) Mylohyoid nerve

Question 66

The mental foramen can typically be palpated

A) At the facial apices of the mandibular first or second premolar
B) Between the facial apices of the mandibular first molar and second premolar
C) Between the apices of the mandibular first premolar and the canine
D) It is best to identify the location on a radiograph as it is difficult to palpate

Question 67

What is the correct depth of penetration for a mental nerve block?

A) 2 to 4 mm
B) 4 to 6 mm
C) 4 to 10 mm
D) 6 to 10 mm

Question 68

What is the correct volume of anesthetic solution for a mental nerve block?

A) 0.4 mL
B) 0.4 mL.
C) 0.6 mL
D) 1.0 mL

Question 69

The incisive nerve is a terminal branch of the

A) Mental nerve
B) Mylohyoid nerve
C) Inferior alveolar nerve
D) Cervical nerve

Question 70

What is the correct depth of penetration for an incisive nerve block?

A) 2 to 4 mm
B) 4 to 6 mm
C) 4 to 10 mm
D) 6 to 10 mm

Question 71

Which of the following represents the recommended volume of anesthetic solution and depth of penetration for an incisive nerve block?

A) 2 to 4 mm; 0.4 mL
B) 4 to 6 mm; 0.4 mL
C) 4 to 6 mm; 0.6 mL
D) 6 to 10 mm; 0.9 mL

Question 72

Which of the following is the recommended clinician position when administering an incisive nerve block using a vertical syringe approach?

A) 6 o'clock
B) 8 o'clock
C) 10 o'clock
D) 12 o'clock

Question 73

Which of the following best describes the nerves anesthetized by a Gow-Gates nerve block?

A) Inferior alveolar, incisive, mental, lingual, buccal
B) Inferior alveolar, lingual, mylohyoid, auriculotemporal, buccal
C) Inferior alveolar, mylohyoid, auriculotemporal, zygomaticofacial
D) Inferior alveolar, incisive, mental, lingual, buccal, zygomaticofacial

Question 74

Which of the following lists describes the correct inferior to superior deposition locations of the mandibular nerve block techniques within the pterygomandibular space?

A) IA, Gow-Gates, Akinosi
B) IA, Akinosi, Gow-Gates
C) Gow-Gates, IA, Akinosi
D) Akinosi, IA, Gow-Gates

Question 75

What is the minimal volume of anesthetic solution recommended for a Gow-Gates nerve block?

A) 0.9 mL
B) 1.5 mL
C) 1.8 mL
D) 3.6 mL

Question 76

Which of the following is not a helpful landmark when determining the penetration site and needle pathway for a Gow-Gates nerve block?

A) Depth of the coronoid notch
B) Flare of the tragus of the ear
C) Labial commissure
D) Mesiolingual cusp of the maxillary second molar

Question 77

Which of the following statements best explains the need to reposition a patient upright with the mouth remaining wide open for up to two minutes after the completion of a Gow-Gates injection?

A) An open mouth allows access to safely remove the syringe and bite block from the mouth, and provides time to rinse and suction the area of injection while preventing aspiration risk in an upright position
B) An upright, open mouth position allows gravity to improve the flow of solution toward the IA nerve, which is located 5 to 10 mm from the deposition site
C) An open mouth allows the condyle to remain fully translated over the articular eminence, preventing the diffusion of solution away from the IA nerve; the upright position facilitates diffusion toward the IA nerve
D) An open mouth allows withdrawal of the syringe without contacting the mandibular occlusal plane; the upright position improves diffusion of the solution toward the IA nerve

Question 78

What are the three key intraoral landmarks for inferior alveolar nerve blocks?

Question 79

Discuss technique errors that lead to failure of anesthesia of the inferior alveolar nerve.

Question 80

Explain why the lingual nerve is usually anesthetized when an IA nerve block is administered.