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Variação da técnica anestésica do bloqueio regional do nervo alveolar inferior: análise ortopantomográfica do posicionamento anatómico do foramen mandibular em função da idade do paciente
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A dor sempre foi uma das maiores preocupações do ser humano, e regularmente é associada aos tratamentos na área da medicina dentária. Várias técnicas anestésicas são utilizadas de forma a poder controlar a dor. O bloqueio regional do nervo alveolar inferior é uma das técnicas anestésicas mais utilizadas em medicina dentária. Contudo o insucesso anestésico é uma realidade. O conhecimento da posição anatómica do foramen mandibular é essencial ao sucesso anestésico. Esta estrutura, que varia em função da idade exige alterações na técnica anestésica.
Objectivos: Demonstrar a importância da análise da ortopantomografia para o sucesso anestésico da técnica do bloqueio regional do nervo alveolar inferior. Avaliar a importância da ortopantomografia na determinação do posicionamento do foramen mandibular em função da idade. Analisar, por grupo etário, a localização das estruturas anatómicas, foramen mandibular, linha oblíqua externa, ângulo da mandíbula, e relacioná-las com a técnica anestésica. Medir a distância do foramen mandibular ao plano oclusal e estabelecer relações entre esta medida e a modificação da técnica anestésica do bloqueio regional do nervo alveolar inferior.
Métodos do estudo: No estudo realizado, a amostra utilizada foi constituída por 80 ortopantomografias, realizadas na Clínica de Medicina Dentária da Faculdade de Ciências da Saúde da Universidade Fernando Pessoa. Foram divididas em função da idade do paciente em 4 grupos etários: dos 6 aos 10, dos 11 aos 16, dos 17 aos sessenta 64, e mais de 65 anos. 20 ortopantomografias em cada grupo das quais pertencentes a 10 pacientes masculinos e dez femininos. O lado medido foi o direito.
Resultados/Discussão: Com o teste ANOVA foi encontrado significado estatístico entre as diferentes variáveis e a idade. Em relação ao género, apenas no grupo dos adultos se obteve significado estatístico. Nas crianças dos 6 aos 10 anos o foramen mandibular foi encontrado maioritariamente abaixo do plano oclusal, em média 1,1 mm. A variação da técnica anestésica descrita para o grupo dos 6 aos 10 anos consiste na modificação da angulação e direcção da agulha, para baixo. A punção será inferior assim como a direcção da agulha. Nesta faixa etária os resultados foram coincidentes. No grupo dos 11 aos 16, está descrito o local de punção a 5 mm acima do plano oclusal, sem variação de angulação da agulha. No estudo o foramen mandibular ficou um pouco mais abaixo, da medida indicada. No grupo dos adultos, onde o local de punção será de 10 mm, obteve-se uma média de 3,3 mm Nos grupo geriátrico a média colocou-se igualmente acima do plano oclusal, a 7,2 mm. A distância da linha oblíqua externa ao foramen mandibular aumentou ao longo da idade, observando-se uma estabilização no grupo dos adultos, grupo 3, em relação ao grupo dos 10 aos 16 anos, grupo 2. Obteve-se uma média no grupo 1 de 21,2 mm e no grupo 4 de 26,4 mm, Nas distâncias do ângulo da mandíbula ao foramen mandibular e do ângulo da mandíbula à linha oblíqua externa observou-se novamente um aumento com a idade e estabilização das médias no grupo dos adultos.
Conclusão: No presente estudo foi possível verificar uma elevada variabilidade anatómica dos pontos de referência do bloqueio regional do nervo alveolar inferior. O médico dentista deverá modificar a técnica anestésica para cada paciente, e a ortopantomografia poderá auxiliar na visualização das referências anatómicas individuais, e assim auxiliar o médico dentista a aumentar o sucesso anestésico na sua prática clínica e consequentemente facilitar o tratamento desejado.
Pain was always one of the biggest concerns of the human being, and regularly it is associated with the treatments in the area of the dental medicine. Several anesthetical techniques are used in order to control pain. The inferior alveolar nerve block is one of the most used anesthetical techniques in dental medicine. However anesthetic failure is a reality. Some authors relate that the knowledge of the anatomic position of mandibular foramen is essential to reach the anesthetic success. This structure that varies in function of age demands alterations in the anesthetical technique. Objectives: Demonstrate the importance of the ortopantomografy analysis for the anesthetic success of the technique of the inferior alveolar nerve block. Evaluate the ortopantomografy’s importance in the determination of the positioning of mandibular foramen, in function of age. Analyze, by age groups, the location of the anatomic structures, mandibular angle, mandibular foramen and external oblique rage, and to relate them with the anesthetical technique. Measure the distance of mandibular foramen to the oclusal plan and to establish relations between this measure and the modification of the anesthetical technique of inferior alveolar nerve block. Methods of the study: In the carried through study, the used sample was constituted by 80 ortopantomografys, collected in the Clinic of Dental Medicine of the College of Sciences of Health of the University Fernando Pessoa. They had been divided in 4 age groups: 6 to 10, 11 to 16, 17 to 64, and more than 65 years. For each group, 20 ortopantomografys were used, divided equally in masculine and feminine patients. The measured side was the right. Results/discussion: With test ANOVA it was found statistician meant between the different variables and the age. In relation to sex, only in the group of the adults was found statistician meant. The variation of the described anesthetical technique for the group of the 6 to 10 years consists on the modification of the angulation and direction of the needle, for low. The punction will be inferior as well as the direction of the needle. In this age group the results were coincident. In children from 6 to 10 years, mandibular foramen was found in majority, below the oclusal plane providing an average of 1.1 mm. In the following groups the resulting average was above the oclusal plan, increasing with the age. In the group from 11 to 16 years, it is verified that the punction’s place is 5 mm above the oclusal plane, without variation of angulation of the needle. In this study, the mandibular foramen was a little lower, than the indicated measure. In the group of adults, where the puntion place is 10 mm, an average of 3,3 mm was observed. In the group of elder, the average was 7.2 mm. The distance of the external oblique ridge to the mandibular foramen increased with the age and was observed stabilization in the group of the adults compared to group 2, the average in group 1 was 21,2 mm and in group 4 was 26,4 mm. In the distances from mandibular angle to mandibular foramen and mandibular angle to the external oblique radge an increase with age and stabilization of the averages in the group of the adults in relation to the previous group, was observed again. Conclusion: According to the observation of the ortopantomografy, the dentist will be able to extract information on mandibular foramen positioning, thus assisting in the execution of the inferior alveolar nerve block. The dentist will have to modify the anesthetical technique for each patient. The ortopantomografy will be useful in the visualization of the individual anatomic references. With this the dentist can reach the anesthetic success in its clinic practice and facilitate the desired treatment.
Pain was always one of the biggest concerns of the human being, and regularly it is associated with the treatments in the area of the dental medicine. Several anesthetical techniques are used in order to control pain. The inferior alveolar nerve block is one of the most used anesthetical techniques in dental medicine. However anesthetic failure is a reality. Some authors relate that the knowledge of the anatomic position of mandibular foramen is essential to reach the anesthetic success. This structure that varies in function of age demands alterations in the anesthetical technique. Objectives: Demonstrate the importance of the ortopantomografy analysis for the anesthetic success of the technique of the inferior alveolar nerve block. Evaluate the ortopantomografy’s importance in the determination of the positioning of mandibular foramen, in function of age. Analyze, by age groups, the location of the anatomic structures, mandibular angle, mandibular foramen and external oblique rage, and to relate them with the anesthetical technique. Measure the distance of mandibular foramen to the oclusal plan and to establish relations between this measure and the modification of the anesthetical technique of inferior alveolar nerve block. Methods of the study: In the carried through study, the used sample was constituted by 80 ortopantomografys, collected in the Clinic of Dental Medicine of the College of Sciences of Health of the University Fernando Pessoa. They had been divided in 4 age groups: 6 to 10, 11 to 16, 17 to 64, and more than 65 years. For each group, 20 ortopantomografys were used, divided equally in masculine and feminine patients. The measured side was the right. Results/discussion: With test ANOVA it was found statistician meant between the different variables and the age. In relation to sex, only in the group of the adults was found statistician meant. The variation of the described anesthetical technique for the group of the 6 to 10 years consists on the modification of the angulation and direction of the needle, for low. The punction will be inferior as well as the direction of the needle. In this age group the results were coincident. In children from 6 to 10 years, mandibular foramen was found in majority, below the oclusal plane providing an average of 1.1 mm. In the following groups the resulting average was above the oclusal plan, increasing with the age. In the group from 11 to 16 years, it is verified that the punction’s place is 5 mm above the oclusal plane, without variation of angulation of the needle. In this study, the mandibular foramen was a little lower, than the indicated measure. In the group of adults, where the puntion place is 10 mm, an average of 3,3 mm was observed. In the group of elder, the average was 7.2 mm. The distance of the external oblique ridge to the mandibular foramen increased with the age and was observed stabilization in the group of the adults compared to group 2, the average in group 1 was 21,2 mm and in group 4 was 26,4 mm. In the distances from mandibular angle to mandibular foramen and mandibular angle to the external oblique radge an increase with age and stabilization of the averages in the group of the adults in relation to the previous group, was observed again. Conclusion: According to the observation of the ortopantomografy, the dentist will be able to extract information on mandibular foramen positioning, thus assisting in the execution of the inferior alveolar nerve block. The dentist will have to modify the anesthetical technique for each patient. The ortopantomografy will be useful in the visualization of the individual anatomic references. With this the dentist can reach the anesthetic success in its clinic practice and facilitate the desired treatment.
Descrição
Monografia apresentada à Universidade Fernando Pessoa para obtenção do grau Licenciado em Medicina Dentária.