Tummalapalli Swathi, M Ravi Sekhar, Inturi Naga Malleswara Rao, V Venkata Ramana Murthy, Suvvari Rama Krishna, Polamarasetty Lakshmi Prasanna
Anil Neerukonda Institute of Dental Sciences, Sangivalasa, Visakhapatnam, India.
J Dent Anesth Pain Med. 2023 Aug;23(4):213-220. doi: 10.17245/jdapm.2023.23.4.213. Epub 2023 Jul 29.
Third molar extraction is the most commonly performed minor oral surgical procedure in outpatient settings and requires regional anesthesia for pain control. Extraction of the maxillary molars commonly requires both posterior superior alveolar nerve block (PSANB) and greater palatine nerve block (GPNB), depending on the nerve innervations of the subject teeth. We aimed to study the effectiveness of PSANB alone in maxillary third molar (MTM) extraction.
A sample size comprising 100 erupted and semi-erupted MTM was selected and subjected to study for extraction. Under strict aseptic conditions, the patients were subjected to the classical local anesthesia technique of PSANB alone with 2% lignocaine hydrochloride and adrenaline 1:80,000. After a latency period of 10 min, objective assessment of the buccal and palatal mucosa was performed. A numerical rating scale and visual analog scale were used.
In the post-latency period of 10 min, the depth of anesthesia obtained in our sample on the buccal side extended from the maxillary tuberosity posteriorly to the mesial of the first premolar (15%), second premolar (41%), and first molar (44%). This inferred that anesthesia was effectively high until the first molars and was less effective further anteriorly due to nerve innervation. The depth of anesthesia on the palatal aspect was up to the first molar (33%), second molar (67%), and lateromedially; 6% of the patients received anesthesia only to the alveolar region, whereas 66% received up to 1.5 cm to the mid-palatal raphe. In 5% of the cases, regional anesthesia was re-administered. An additional 1.8 ml PSANB was required in four patients, and another patient was administered a GPNB in addition to the PSANB during the time of extraction and elevation.
The results of our study emphasize that PSANB alone is sufficient for the extraction of MTM in most cases, thereby obviating the need for poorly tolerated palatal injections.
拔除第三磨牙是门诊最常见的小型口腔外科手术，需要局部麻醉来控制疼痛。上颌磨牙的拔除通常需要同时进行上牙槽后神经阻滞（PSANB）和腭大神经阻滞（GPNB），具体取决于患牙的神经支配情况。我们旨在研究单独使用PSANB在上颌第三磨牙（MTM）拔除中的有效性。
选取100颗已萌出和半萌出的MTM作为样本进行拔除研究。在严格的无菌条件下，患者仅接受使用2%盐酸利多卡因和1:80,000肾上腺素的经典PSANB局部麻醉技术。在10分钟的潜伏期后，对颊侧和腭侧黏膜进行客观评估。使用数字评分量表和视觉模拟量表。
在10分钟的潜伏期后，我们样本中颊侧获得的麻醉深度从后方的上颌结节延伸至第一前磨牙近中（15%）、第二前磨牙近中（41%）和第一磨牙近中（44%）。这表明直至第一磨牙麻醉效果良好，而由于神经支配，再向前则效果较差。腭侧的麻醉深度达第一磨牙（33%）、第二磨牙（67%），从外侧至内侧；6%的患者仅牙槽区域获得麻醉，而66%的患者麻醉范围达腭中缝1.5厘米。5%的病例需要重新进行局部麻醉。4名患者额外需要1.8毫升PSANB，另一名患者在拔牙和牙挺挺出时除PSANB外还接受了GPNB。
我们的研究结果强调，在大多数情况下，单独使用PSANB足以拔除MTM，从而无需进行耐受性较差的腭部注射。
