Local Anesthesia in the Orofacial Region

Abstract

Local anesthesia techniques in oral and maxillofacial procedures are very common and routinely performed daily. An overwhelming role of local anesthetics is to decrease intra- and postoperative pain following orofacial procedures. In addition, proper administration of orofacial local anesthetics will improve patient cooperation and comfort, provide an environment for diagnostic testing and examination, and eliminate or reduce the amount of conscious sedation and general anesthesia that may be necessary in the office or the operating room. There are hosts of anatomical considerations to be considered when performing administration of local anesthesia in the orofacial region. Anatomical consideration begins with the trigeminal nerve and awareness and understanding of both the sensory and motor division of innervations. Local anesthetic instrumentation, materials, and supplies for performing such techniques and optimal utilization of such instruments remain a necessary competency. Three major types of maxillary anesthesia injections can be performed for pain control and include local infiltration, field block, and nerve blockade. Due to the dense cortical bone of the mandible, local anesthesia infiltration techniques in the adult are not frequently performed. Nerve blocks utilized for mandibular anesthesia include the inferior alveolar, lingual, mental, and buccal nerves. Local anesthetic types used during local anesthesia in the orofacial region include esters and amides, and each class can have specific drugs with duration of action ranging from short to long acting. Evidence-based local anesthesia dosing considerations between adults and children and in those patients with cardiovascular comorbidities have been developed. There remains a host of concern for the concept of complications and side effects with local anesthesia administrations and complications with local anesthesia techniques in oral and maxillofacial procedures.