Inferior Alveolar Nerve Block by Injection Into the Pterygomandibular Space Using Guiding Devices: A Systematic Review

Abstract

The aim of our research was to analyze and compare different inferior alveolar nerve blocking techniques and the effectiveness of various guiding devices. Methods: A search was conducted on specialized databases for search and selection of works in which a guiding device for lower alveolar nerve block (IANB) was described. The propriated articles were evaluated and selected in 3 stages for final review based on predefined criteria, followed by a critical evaluation stage. As the research result - various types of IANB guide devices and the results of its using were recorded and analyzed. Results: The systematic review of devices for conducting IANB was done. The success of IANB can be achieved by adjusting the syringe with the anesthetic needle trajectory — it increased the probability of a successful hit in the area of the mandible foramen. Examples of devices in which the syringe is fixed at the moment when the tip of the needle is injected into the medial side of the branch of the lower alveolar nerve are considered. And also, the special techniques based on orientation on the soft tissues are described. However, when creating a device of this type, the following factors must be taken into account: the angle of the needle to the insertion point, the position of the insertion point relative to the anatomical landmarks (taking into account individual characteristics), and the insertion depth. Also, other IANB guiding blockade methods are considered: 3D navigation while local anesthetic injection. Thus, the patient's discomfort, the risk of nerve damage and the risk of unsuccessful mandible anesthesia could be minimized. Conclusion: The advantages and disadvantages of these anesthesia methods, the success rate, and patient comfort were analyzed. Prospects for further research in this area were identified.