Presentation Category
Research
Introduction/Context/Diagnosis
Pediatric inferior alveolar nerve block landmarks are poorly defined and quantitative assessments of their efficacy are unavailable. We assessed landmarks/planes employed in pediatric IA blocks, and a new landmark, to establish their value.
Methods/Treatment Plan
Fifty-one skulls (2.5-8.0 years) were CT-scanned and assigned to five groups. For each individual, a mandible was articulated with the glenoid cavity and eminence (opening =21 mm). Parallel orthoslices at the occlusal and coronoid notch planes simulated injection height. Needle trajectory (orthoslices) was approximated by bisecting the dC, dM1, or dM1-dM2 interproximal region and the alveolar process-pterygoid plate junction. Landmarks intersected the occlusal/coronoid notch planes and vertical planes passing through the lower teeth to the mandibular foramen.
Results/Outcome
Mandibular positioning on the eminence is critical. Inappropriate needle position resulted when using the canine and occlusal or coronoid notch landmarks (90.2%, 56.9%, respectively). Appropriate needle positioning was achieved using the deciduous molars and occlusal (64.8%) or coronoid notch plane (87.2%). Combining the coronoid notch and dM1 or dM1-dM2 junction resulted in 82.4% and 90.2% correct placement, yet lower percentages with the occlusal (66.7%, 62.8%, respectively). Idiosyncratic differences impacted the few existing needle placement failures.
Significance/Conclusions
Understanding needle placement is critical for anesthetizing nerves and achieving rapid, complete pediatric nerve block.
Format
Event
Inferior Alveolar Nerve Block in Pediatric Patients: Quantitative Assessment
Pediatric inferior alveolar nerve block landmarks are poorly defined and quantitative assessments of their efficacy are unavailable. We assessed landmarks/planes employed in pediatric IA blocks, and a new landmark, to establish their value.
Comments/Acknowledgements
UOP Department of Biomedical Sciences, Center of Dental History and Craniofacial Study, and Department of Radiology of CPMC Hospital.