Needle position in relation to the occlusal and coronoid notch planes and anesthesia in children and juveniles
Presentation Category
Research
Introduction/Context/Diagnosis
Earlier (Lambert et al., 2017) we demonstrated the efficacy of new inferior alveolar nerve (IAN) block landmarks in adolescents-adults and their validity in infants-juveniles (Soi et al, 2018). We present a refined assessment of distances and injection pathways to better assess these landmarks.
Methods/Treatment Plan
Skulls (N=30) were CT scanned. Three groups (2.5-3.9, 5.9-6.9, and 7.1-7.9 years) were established (10 per/group). Models of the cranium and two mandibles were made with one positioned on the articular eminence, one in the glenoid cavity. The upper-to-lower incisal distance is 21-23 mm. Orthoslices represent the occlusal, coronoid notch, buccinator, and injection planes (dm 1 -dm 2 -posterior maxillary tuberosity). Long and short needle penetration was evaluated.
Results/Outcome
Relative to the occlusal plane the foramen was 0-2.0 mm below in Group 1 and 0- 4.4 mm below in Group 2. Distances varied for Group 3 with some foramina below/above the plane (-2.57-4.81 mm). Relative to the coronoid notch plane the foramen was below it as follows: Group 1, 2.2-6.7 mm, Group 2, 1.5-4.5 mm, and Group 3, 1.4-5.6 mm.
Significance/Conclusions
In adolescents-adults the landmarks predict final needle position in ~90% of cases. We show a high degree of success in needle placement above the foramen in infants- juvenile, making the landmarks applicable to all age groups. The coronoid notch is preferable to the occlusal plane in infants-juveniles as it always positions the needle ~2-5.5 mm above the foramen. Use of these landmarks should allow a decrease in the amount of anesthesia employed as it is being injected in close proximity to the IA nerve.
Format
Event
Needle position in relation to the occlusal and coronoid notch planes and anesthesia in children and juveniles
Earlier (Lambert et al., 2017) we demonstrated the efficacy of new inferior alveolar nerve (IAN) block landmarks in adolescents-adults and their validity in infants-juveniles (Soi et al, 2018). We present a refined assessment of distances and injection pathways to better assess these landmarks.
