Neurophysiology of LA Neurophysiology of LA

Definition of LA:A loss of sensation in a circumscribed area of the body caused by a depression of excitation in nerve endings or an inhibition of the conduction process in peripheral nerves.

PROPERTIES OF LA:1.It should not be irritating to the tissue. 2.It should not cause any permanent alteration to the tissues. 3.Its systemic toxicity should be low. 4.It should be effective regardless of whether it is injected into the tissues or applied locally to mucous membrane. 5.The time of onset of LA should be as short as possible. 6.The duration of action must be long enough to complete procedure yet not so long as to require an extended recovery. 7.It should have potency sufficient to give complete anesthesia without the use of harmful concentrated solutions. 8.It should be relatively free from producing allergic reactions. 9.It should be stable in solution & readily undergo biotransformation in the body. 10.It should be sterile or capable of being sterilized by heat without deterioration.

Neuron:
• It is the structural unit of the nervous system. • It is able to transmit message between the nervous system & all parts of the body. 2 TYPES: -SENSORY NEURON -MOTOR NEURON

PARTS OF NEURON:
1.Dendritic zone-It respond to stimulation produced in the tissues in which they lie provoking an impulse that is transmitted centrally along the axon. 2.Axon- It is a thin cable like structure transmits impulses. 3.Cell Body- Provides the vital metabolic support for the entire neuron.

TYPES OF NERVE FIBERS:
• Myelinated nerve fiber • Unmyelinated nerve fiber The insulting properties of the myelin sheath enable a myelinated nerve to conduct impulses at a much faster rate than can an unmyelinated nerve of equal size.

Electrophysiology of nerve conduction:
• Step 1- A stimulus excites the nerve leading to the following sequence of events; A.Initial phase of slow depolarization. B.Firing threshold-When the falling eletrical potential reaches a critical level. C.Rapid repolarization – The interior of the nerve is now eletrically positive in relation to the exterior. Step 2-After these steps of depolarization occurs .The electrical potential gradually becomes more negative inside the nerve cell relatively to outside until the resting potential of -70mV is again achieved.

Theories of LA:
1.Acetylcholine theory 2.Membrane expansion theory 3.Specific receptor theory

Mechanism of action of LA :
1.Displacement of Ca ions from the Na channel receptor site which permits.. 2.Binding of LA molecule to this receptor site which thus produces… 3.Blockade of the Na channel & a 4.Decrease in the Na conductance which leads to 5.Depression of the rate of electrical depolarization & a 6.Failure to achieve the threshold potential level along with a 7.Lack of development of propagated action potentials,which is called 8.Conduction blockade.

Maxillary nerve:• Maxillary nerve is one of the three divisions of the trigeminal nerve. • It is entirely sensory in function. Course:- -Maxillary nerve originates at the middle of the semilunar ganglion & continues forward in the lower part of caverous sinus. -Then passes to the foramen rotundum through which it leaves cranial fossa. -Then enters the inferior orbital fissure to pass into the orbital cavity,here it turns laterally in a groove on the orbital surface of maxilla, called infraorbital groove. -Continuing forward the second division emerges on the anterior surface of the maxilla through the infraorbital foramen where it divides.

Branches of maxillary nerve:
1. 2. Branch within the cranium:Middle meningeal nerve Supply- sensory innervation to the dura mater. Branch within the pterygopalatine fossa:Branches of the pterygopalatine nerves include those that supply 4 areas: Orbital branchessupply- periosteum of the orbit Nasal branchessupply-mucous membrane of of superior & middle conchae,lining of the posterior ethmoidal sinuses,posterior portion of nasal septum.

Palatine branches:
-Greater palatine n -lesser palatine n

part of the pharynx

Pharyngeal branches: supply- mucous membrane of the nasal
-posterior to auditory tube.

3. Branches in the infraorbital canal:
-Middle superior alveolar N: Provides sensory innervation to: -2 maxillary premolars -mesiobuccal root of first molar & periodontal tissue -Buccal soft tissue -Bone in the premolar region -Anterior superior alveolar N: descends within the anterior wall of the maxillary sinus supply- -pulpal innervation to the central & lateral incisors & canine -sensory innervation to the periodontal tissues, buccal bone, mucous membrane of these teeth.

4. Branches on the face:
Infraorbital N emerges through the infraorbital foramen onto the face to divide into terminal branches: -Inferior palpebral branchsupply- Skin of the lower eyelid with sensory innervation. -External nasal branchessupply- Sensory innervation to the skin on the lateral aspect of the nose. -Superior labial branchessupply-sensory innervation to the skin & mucous membrane of the upper lip. •

Mandibular Nerve:It is one of the largest divisions of the trigeminal nerve. It is formed by the union of the large sensory bundle of fibers & a small motor bundle of fibers.

Branches of mandibular n:
1.Branches from the undivided n: Nervous spinosus-Arises out side the skull & then passes into the middle cranial fossa to supply the dura mater & mastoid cells. N to internal pterygoid muscle-A branch of the motor root passes to innervate the internal pterygoid muscle. This branch passes without interruption to innervate the tensor veli palatini & tensor tympani muscles. 2.Branches from the divided N: Below the level of the undivided part of the mandibular division the trunk separates into 2 parts. Anterior division posterior division

A)

Anterior Division:

The anterior division is smaller than the posterior division.It receives sensory & motor fibers that supply the – muscles of mastication - skin & mucous membrane of the cheek -Buccal gingiva & lower molars It passes downwards & forwards where it divides1.Pterygoid N- Enters the medial side of the external pterygoid muscle to provide its motor n supply 2.Masseter N-Masseter N passes above the external pterygoid to traverse the mandibular notch & enter the deep side of masseter muscle.

3.N to temporal muscle:Anterior deep temporal N Posterior deep temporal N 4.Buccal N:It provides sensory innervation to buccinator muscle

B) Posterior division:
• The largest posterior division is sensory but also carries some motor components.
This division extends downwards & medially & then branches into the –auriculotemporal n - lingual n -inferior alveolar n 1)Auriculotemporal N:supply -Tragus of pinna of external ear -To scalp -As for upward as the vertex of the skull

2) Lingual nerve: It is the smaller of the two terminal branches of the posterior division of the mandibular nerve. It contributes many sensory fibers to the mucous membrane of the the floor of the mouth & gingiva on the lingual surface of the mandible. It occasionally supplies sensory fibers to the bicuspids & first molar teeth. 3) Inferior alveolar nerve: It is the largest of the branches of the posterior division of the posterior division of the mandibular n. On the medial side of the ramus in the pterygomandibular space,it enters the mandibular foraen. Within the mandible the inferior alveolar n descends in the inferior alveolar canal & distributed throughout the body of the mandible. I inferior alveolar canal - It gives of branches to the mandibular teeth to supply the dental pulps. Someof the fibers are distributed to the periodontal membrane of the various lower teeth.

-At region of mental foramen – Gives mental nerve. Supply- skin of the chin & lower lip & to the mucous membrane lining the lower lip. -At the region of incisive foramen- Gives incisive nerve. Supply- cuspid tooth & incisor teeth 4)Mylohyoid nerve – Before the inferior alveolar nerve enters the mandibular foramen it gives off a branch the mylohyoid nerve. Supply – Motor fibers – to the anterior belly of digastric muscle. Sensory fibers- Enter the mandible in the area of the chin to aid in the sensory nerve supply to the mandibular incisors.

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