Complications of local

anaesthesia
1.General complications
2.Local complications
► Theprimary sensory nerve of the Oro-facial
area is the trigeminal nerve.
 Trigeminal nerve
► The Trigeminal nerve is mixed Cranial nerve comprises principally of neurons
forsensation.
► It enters the trigeminal ganglion after travelling parallel to the pons surface and exiting
the brain. The trigeminal ganglion makes up the spinal nerveby acting as the dorsal root
ganglion.
► The trigeminal ganglion divides into three major branches, innervating different bone,
teeth and facial dermatome. Every branch follows a different path and site to exit the
cranium.
► The Opthalmic nerve, the primary V1 branch, exits via the superior orbital fissure of the
cranium, reaching the orbit to innervate the skin existing above the forehead and eye as
well as the globe of the eye.
► The Maxillary nerve makes the second V2 division, leaving via the foramen rotundum,
into the pterygopalatine fossa, an area located posterior to the orbit. Thereafter, it again
enters the inferior orbital fissure, making its way to the infraorbital foramen on the face,
innervating the skin of the nose and cheek and below the eye.
► The Mandibular nerve, the V3 third division, also has a motor component leavewith the
nerve and joining it at the foramen ovale (the motor root).
 1. General complications

► A. Toxic
► B. Allergic
 A. Toxic symptoms- resulting from
an overdose
► Toxic
effect as a result of high levels of the
anaesthetic drug in the patient’s body blood
(common)

► General nervous system

► Spasms and respiratory depression

A/1
► Adrenaline effect vasoconstriction

► Ifthe injection is given directly into the

blood vessels (side effect)
 B. Allergic reaction
► Allergic reaction of amide type (Lidocain)
injection is extremely rare! (Ultracain
alternative)
► The stabilizer acts (methylparaben)
as an allergen more frequently than does
the basic compound!
 2. Local complications
► a. haematoma
► b. infection
► c. nerve damage
► d. trismus
► e. facial paresis
► f. lip and tounge injuries
 a. Haematoma

► Damage of the vessels

► Venous origin (tuberal injection)
► Blue color swelling on the mucosa or face
 b. Infection

► Severe inflammatory reaction

► Injected abscess
► AB could be necessary and incision
 c. Nerve damage

► Inferior alveolar or lingual nerve

► Electric shock-like sensation
► Nerve injuries paraesthesia
 d. Trismus
alveolar inferior nerve block

► Anaesthetic among ► Infection introduced

medial pterygoid with the needle
muscle fibers
 e. Facial paresis
► The needle is introduced too deeply
facial nerve block

► Transient paralysis of the mimic muscle

 f. Lip and tounge injuries

► Lossof sensation caused by alveolar inferior

nerve block
► Local anaesthesia
extraorally
 Extraoral anaesthesia
► When the approach for any procedure is
made outside the oral cavity in the head
and neck region
 Etiology
► Infection
► Pathology
► Trismus
► Trauma
► When intraoral methods have been
ineffective
► Diagnostic or therapeutic purposes
 Types
► Extraoral infraorbital nerve block
► Extraoral maxillary nerve block
► Extaroral mandibular nerve block
► Mental and incisive nerve block
Extraoral Infraorbital nerve block
► Anasthetised nerves:
► 1. Infraorbital
► 2.Inferior palpebral, lateral nasal and
superior labial nerves
► 3. Anterior and middle superior alveolar
nerves
► 4.Sometimes posterior superior alveolar
nerves
► Anaesthised area
► Incisors on the injected side
► Labial alveolar part and overlying tissue
► Upper lip and the same side nose and lower
eyelid
 Anatomical landmarks
► Pupil of he eye
► Infraorbital ridge
► Infraorbital notch
► Infraorbital depression
 Maxillary nerve extraoral block
(Braun technique)
► Under the zygomatic bone,by the masseter frontal belly the needle is
inclinated 30 degrees and the needle goes directly 3-4 cm till the
maxillary tuber. Than we take a smal curve around it and after 2 cm
the fossa pterygolaptina is reached.
 Maxillary nerve extraoral block
(Payr technique)
► Overthe zygoma (palpate the edge) we go
downwards and backwards 5,5 cm till the
nervebranch.
 Mandibular extraoral nerve bock
(Braun technique)
► This extra-oral closed mouth technique has the goal of delivering local anesthesia to the
third division of the trigeminal nerve just shortly after it exits out of the foramen ovale.
► The zygomatic arch is palpated and the halfway point of the arch is identified. A needle n
is advanced, perpendicular to skin, directed towards the lateral pterygoid plate. Depthhas
been reached once bone is encountered. This distance is then marked with a skinmarker
on the surface of the protruding needle. The needle is partially withdrawn and redirected
posteriorly at an angle of 30 degrees and advanced until the previous marked depth is
reached. The needle tip will be adjacent to the foramen ovale .
► Toensure that the needle is not intravascular, aspiration is performed.
► Because of close proximity of internal carotid artery the needle tip is rotated 90 degrees
and a secondaspiration is performed. If both are negative then local anesthetic is
delivered6

► Braun’s technique describes the injection of anesthetic solution near the

foramen ovale by inserting the needle along the inferior aspect of the
zygomatic arch at its midpoint; then, after touching the pterygoid process and
reangulating the needle posteriorly, V3 anesthesia will take place.
► The main point is the edge of the zygoma
and the incisura semilunaris.
► 5 cm forward the lateral lamina of the
pterygoid process takes place.
► A bit backwards the foramen ovale could be
found.
 Berg (Kantorowicz)
► This is a closed-mouth, transcutaneous ,extra-oral technique .A 25-gauge needle is
inserted medial to the body of the mandible. One to one and a half cm anterior to angle
of the mandible but posterior to the antegonial notch to stay posterior to the facial
vessels. The needle is inserted 4.5 cm and inserted along the medial side of the
mandibular ramus parallel to the posterior border.
► Delivers local anesthetic within the ptergyomandibular space adjacent to the mandibular
foramen by inserting the needle in a transcutaeous fashion in the submandibular region
along the medial aspect of the mandible.
 Lindemann
► Both maxillary and mandibular nerve
► We push the needle over the zygomatic arch
and go straigth by the infratemporal surface of
the temporal bone. Than we reach the pterygoid
process.
► We pull the needle a little bit backwards and we
go dorsally 1 cm and reach the oval foramen.We
infiltrate 2 ml liquid.
► If we go ventrally 1 cm from the point of impact
the maxillary nerve is anasthetaised as well.
Thank you for
your attention!