. Regional anesthesia : its technic and clinical application . olar tooth, a little lateral to the dental arch, and advanced2 cm. backward, along a line parallel to the arch; 2 of the 2per cent, solution are then injected slowly, while the needle is movedslightly to and fro. The dentists implements may also be usedfollowing the same technic. BLOCKING OF CRANIAL NERVES IO7 Extra-oral Route.—The angle of the jaw is defined and marked bya wheal raised just a little below it. The tip of the forefinger of the lefthand, placed in the depression of the sigmoid notch immediately belowthe zygomati
. Regional anesthesia : its technic and clinical application . olar tooth, a little lateral to the dental arch, and advanced2 cm. backward, along a line parallel to the arch; 2 of the 2per cent, solution are then injected slowly, while the needle is movedslightly to and fro. The dentists implements may also be usedfollowing the same technic. BLOCKING OF CRANIAL NERVES IO7 Extra-oral Route.—The angle of the jaw is defined and marked bya wheal raised just a little below it. The tip of the forefinger of the lefthand, placed in the depression of the sigmoid notch immediately belowthe zygomatic arch, defines the coronoid process in front of it. Halfthe distance between the wheal and the process is recorded by a smallpiece of rubber, or cork, threaded on needle No. 2. The needle isinserted through the wheal and advanced in an upward, inward, andfrontward direction, along the medial aspect of the ascending ramus,toward the coronoid process (Fig. 81), until the recorder reaches theskin surface; 2 of the 2 per cent, solution are then injected,. Angle of JQU/ Fig. 81.—Inferior dental block by the route. The arrow shows the directionof the needle in relation to the ascending ramus of the mandible. while the needle is slightly moved to and fro. Here again it isadvisable not to force the needle through the dense tissues overljdngthe bone, but to make it pass just tangent to these tissues. The first procedure is very accurate and should be used when thelower molars are present. The second, in the hands of a trained man,is as accurate as the first, and is indicated when the upper molars arepresent. The last is of the highest value when all the molars areabsent, and also in cases of trismus. The inferior dental block is indicated for multiple ofteeth and all operations on the body of the mandible. When the opera-tion involves the chin or lower lip bilateral block should be made, or Io8 REGIONAL ANESTHESIA at least the dental block on one side
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