CLINICAL ASSESSMENT OF THE EFFECTIVENESS OF CONDUCTION ANESTHESIA USED DURING SURGERY IN THE LATERAL AREA OF THE MANDIBLE

Mokryk O. Ya., Petrov D. B., Komnatskyi B. Yu.

DENTISTRY

Scentific article

Abstract. The article presents the results of the study of clinical efficacy of using of modern methods of conduction anesthesia of peripheral branches of the mandibular during planned surgical interventions in the lateral area of the mandible – atypical removal of the impacted lower third molar (86 cases) and odontogenic cystectomy (61 cases). Depending on the applied methods of conduction anesthesia, patients were divided into three clinical groups. In patients of the control group, the standard intraoral technique of mandibular anesthesia was used according to S. N. Weisblat. In patients of the comparison group was performed torus anesthesia (by Weisbrem’s method). In patients of the main group, a modified method of torus anesthesia was used according to R. B. Sarmanayev – “torusmandibular” anesthesia. The retromolar area was additionally anesthetized with infiltration anesthesia, because of the presence of pain sensitivity. At incomplete loss of pain sensitivity in the area of the lower molars (according to the results of “pin-prick” test and electroodontometry), after conduction anesthesia of the lower alveolar, lingual and buccal nerves, the mylohyoid nerve blockade by our improved method was performed. It was carried out in the mylohyoid groove, located on the inner surface of the body of the mandible. Additionally we performed infiltration anesthesia of the submasseteric space to block the maxillary branch of the great auricular nerve, in case of pain during shell enucleation of the odontogenic cyst, sprouted in the branch of the mandible. During the surgical manipulations, the emotional-motor manifestations of pain stress in patients were evaluated according to the scale of Sounds, Eyes and Motor and autonomic response by perfusion index (PI) and pulse rate. Statistical processing of the study results was performed using Student’s t-test and Pearson’s coefficient χ2 . After analyzing the obtained results of anesthesiological support of planned surgical interventions on the mandibles, it can be stated that there is a relationship between the achieved anesthetic effect and the applied methods of conduction anesthesia. Torus-mandibular anesthesia by R. B. Sarmanayev is statistically significantly more effective than classical mandibular anesthesia according to S.N. Weisblat – χ2 =16,318 (р<0,001) and the standard torus – χ2 =3,864 (р=0,050).

conduction anesthesia, mandible, surgical interventions, pain reaction, psycho-emotional stress.

1. Astramskaitė I, Poškevičius L, Juodžbalys G. Factors determining tooth extraction anxiety and fear in adult dental patients: a systematic review. Int J Oral Maxillofac Surg. 2016 Dec;45(12):1630-1643.
2. Eroglu CN, Ataoglu H, Küçük K. Factors affecting anxiety-fear of surgical procedures in dentistry. Niger J Clin Pract 2017;20:409-14.
3. Van Houtem CMHH, van Wijk AJ, Boomsma DI, Ligthart L, Visscher CM, De Jongh A. The factor structure of dental fear. Eur Journal Oral Sci 2017;125:195-201.
4. Sakamoto E, Yokoyama T. Pain and Anxiety in Dentistry and Oral and Maxillofacial Surgery Focusing on the Relation between Pain and Anxiety. Annals Pain Med. 2018;1(1):1002.
5. Gordeyev AV, Shamshadinova AR, Lapa VV. Vybor obezbolivaniya pri operatsiyakh v chelyustno-litsevoy oblasti. Byulleten’ meditsinskikh Internet – konferentsiy. 2015;5(10):1173. [in Russiаn].
6. Abdulkadir BÇ, Çağrı A, Neşe K, Banu G K. Oral surgical procedures under local anaesthesia in day surgery. BMC Oral Health. 2018;18:179.
7. Kanakaraj M, Shanmugasundaram N, Chandramohan M, Kannan R, Perumal SM, Nagendran J. Regional anesthesia in faciomaxillary and oral surgery. J Pharm Bioallied Sci. 2012 Aug; 4(2):264-9.
8. Rabinovich SA, Vasil’yev YUL. Anatomo-topograficheskiye i instrumental’nyye aspekty mestnogo obezbolivaniya v stomatologii. Moskva: Chuvashiya; 2011. 144 s. [in Russiаn].
9. Tarasenko SV, Dydykin SS, Kuzin AV. Anatomo-topograficheskoye i rentgenologicheskoye obosnovaniye provedeniya dopolnitel’nykh metodov obezbolivaniya zubov nizhney chelyusti s uchetom variabel’nosti ikh innervatsii. Stomatologiya. 2013;5:44-8. [in Russiаn].
10. Khoury J, Mihailidis S, Ghabriel M, Townsend G. Anatomical relationships within the human pterygomandibular space: Relevance to local anesthesia. Clinical Anatomy. 2010;23(8):936 – 944.
11. Anisimov MV, Kholodkova YEL, Dashkevich GB. Kliniko-anatomicheskiy analiz prichin neudovletvoritel’nykh rezul’tatov provodnikovoy anestezii na nizhney chelyusti. Innovatsii v stomatologii. 2014;3:65-70. [in Russiаn].
12. Rodella LF, Buffoli B, Labanca M, Rezzani R. A review of the mandibular and maxillary nerve supplies and their clinical relevance. Arch Oral Biol. 2012 Apr;57(4):323-34.
13. Ella B, Langbour N, Caix P, Midy D, Deliac P, Burbaud P. Transverse cervical and great auricular nerve distribution in the mandibular area: a study in human cadavers. Clin Anat. 2015 Jan;28(1):109-17.
14. Kim S, Feldman DU, Yang J. A Systematic Review of the Cervical Plexus Accessory Innervation and Its Role in Dental Anesthesia. J Anesth Hist. 2016 Jul;2(3):79-84.
15. Von Arx T, Abdelkarim AZ, Lozanoff S. The Face – A Neurosensory Perspective. A literature review. Swiss dental journal SSO. 2017;127:1066–1075.
16. Yegorov PM. Mestnoye obezbolevaniye v stomatologii. М.; 1985. 169 s. [in Russiаn].
17. Mokryk OYа. Otsinka efektyvnosti rozroblenoyi metodyky anesteziyi shchelepno-pidʺyazykovoho nerva pry khirurhichnykh vtruchannyakh u dilyantsi kutnikh zubiv nyzhnʹoyi shchelepy. Praktychna medytsyna. 2010;16(6):28-32. [in Ukrainian].
18. Sahrish L, Afeefa E, Syed Gulzar AВ. Efficacy of greater auricular nerve infiltration anesthesia in patients having less than optimal analgesia after conventional inferior alveolar nerve block for surgical removal of mandibular third molar. Pakistan Oral & Dental Journal. 2011;31(2):252-4.
19. Smith MH, Lung KE. Nerve Injuries after Dental Injection: A Review of the Literature. J. Can Dent Assoc. 2006;72(6):559-64.
20. Kharchenko YuA. Adekvatnaya otsenka boli–zalog yeyo uspeshnogo lecheniya. Universum: Meditsina i farmakologiya. 2014;4(5):1-18. Dostupno: http://7universum.com/ru/med/archive/item/1229. [in Ukrainian].
21. Wright GZ, Weinberger SJ, Marti R, Plotzke O. The effectiveness of infiltration anesthesia in the mandibular primary molar region. Pediatr Dent. 1991;13:278-83.
22. Raouf Mohameda SA, Mohameda NN, Rashwanb D. Pulse co-oximetry perfusion index as a tool for acute postoperative pain assessment and its correlation to visual analogue pain score. Research and Opinion in Anesthesia & Intensive Care. 2015;2(3):62-7.
23. Boyaci TA, Küçük A, Şakalar A, Sert H, Yalçin Ş. Perfusion Index is Increased in Acute Complex Regional Pain Syndrome Type. Arch Rheumatol. 2015;30(1):40-4.
24. Tapar H, Suren M, Karaman S, Dogru S, Karaman T, Sahin A, et al. Evaluation of the perfusion index according to the visual analog scale in postoperative patients. Saudi Med J. 2018;39(10):1006-10.
25. Choi P, Iwanaga J, Dupont G, Oskouian RJ, Tubbs RS. Clinical anatomy of the nerve to the mylohyoid. Anat Cell Biol. 2019;52(1):12-6.
26. Khoury JN, Mihailidis S, Ghabriel M, Townsend G. Applied anatomy of the pterygomandibular space: improving the success of inferior alveolar nerve blocks. Aust Dent J. 2011 Jun;56(2):112-21.
27. Kim HJ, Park BS, Cho Y, Yu SK. Course of buccal nerve on the anterior border of mandibular ramus related to temporalis tendon. Oral Biol Res. 2017 Dec;41(4):236-9.
28. Fan S, Chen WL, Pan CB, Huang ZQ, Xian MQ, Yang ZH, et al. Anesthetic efficacy of inferior alveolar nerve block plus buccal infiltration or periodontal ligament injections with articaine in patients with irreversible pulpitis in the mandibular first molar. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Nov;108(5):89-93.
29. Thotakura B, Rajendran SS, Gnanasundaram V, Subramaniam A. Variations in the posterior division branches of the mandibular nerve in human cadavers. Singapore Med J. 2013;54(3):149-51.
30. Shiozaki H, Abe S, Tsumori N, Shiozaki K, Kaneko Y, Ichinohe T. Macroscopic anatomy of the sphenomandibular ligament related to the inferior alveolar nerve block. The journal of craniomandibular practice. 2007 Jul;25(3):160 – 5.

«Bulletin of problems biology and medicine» Issue 1 (159), 2021 year, 369-373 pages, index UDK 617.513-089.5-089.11-036-037

10.29254/2077-4214-2021-1-159-369-373