PubMed · 1517519
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P A Moore. 1992. Preventing local anesthesia toxicity.. https://doi.org/10.14219/jada.archive.1992.0239
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Ultrasonic bone-cutting surgery has been recently introduced as a feasible alternative to the conventional tools of cranio-maxillo-facial surgery, due to its technical characteristics of precision and safety. The device used is unique in that the cutting action occurs when the tool is employed on mineralized tissues, but stops on soft tissues. This technical note illustrates the use of Piezosurgery for all osteotomies of surgically assisted rapid maxillary expansion (SARME). The procedure, including pterygo-maxillary detachment, can be completed under local anaesthesia. Other advantages include minimal risk of jeopardizing critical anatomic structures (e.g. palatine artery), minimal intraoperative bleeding and postoperative swelling, and minimal thermal damage to bone surfaces. Narrow and rectilinear osteotomies can be easily performed with varying vibrating scalpels, at the cost of a longer operative time.
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Correct identification of the causes of dental anesthetic failure is essential in order to adopt the required measures for successful anesthesia. A review is made of the factors implicated in locoregional anesthesia failure, such as a bifid inferior alveolar nerve, retromolar foramen associated to accessory innervation, double or accessory mental foramen, the relation between the infiltration technique and bone density, accessory innervation in the case of the mylohyoid nerve and first cervical branches, cross innervation of the incisors, inactivity in the presence of tissue inflammation, inactive anesthetic solutions, an incorrect technique, and subjective perception on the part of particularly anxious patients. The therapeutic options available in the event such problems are encountered in routine clinical practice are commented.