PDF: Dental Anesthesia - Akinosi nerve block

The Akinosi injection technique is one of the methods available for anesthetizing the inferior alveolar nerve.

The Akinosi technique is unique in several ways: the maxillary teeth are used as a guide for syringe orientation, needle contact with bone is not necessary, and the patient’s mouth is closed throughout the procedure.

The final position of the tip of the needle is in the mid to upper portion of the pterygomandibular space and in close relation to the mandibular nerve. The inferior alveolar, lingual, mylohyoid and in some instances the buccal nerve are anesthetized with this block. 

This technique is useful in anxious patients, patients with limited mouth opening secondary to trismus or trauma, and for the patient who is unable to maintain mouth opening for the conventional and Gow-Gates technique for anesthetizing the inferior alveolar nerve.

The relevant landmarks for administering the Akinosi injection are a line parallel to the occlusal plane of the maxillary molars and penetration of the needle medial to the ramus of the mandible at the height established by mucogingival line of the maxillary molars. 

The needle penetrates the tissue medial to the ramus and is advanced the full length of a long needle. The tip of the needle now lies in the mid to upper portion of the pterygomandibular space.

The lip and cheek are retracted taut with the finger resting on the anterior border of the ramus of the mandible. The syringe is oriented parallel to the maxillary occlusal plane at the height of or just above the mucogingival junction of the maxillary molars.

The barrel of the syringe must be positioned gently against the maxillary alveolus throughout the injection process. At this vertical height, the needle penetrates the mucosa so that the needle passes about 3-5 mm medial to the anterior border of the ramus of the mandible. 

Small amounts of local anesthetic are deposited ahead of the needle as it passes through the tissues. However, the bulk of the anesthetic in the cartridge should be preserved for deposition at the final target site to ensure an adequate volume of local anesthetic in the pterygomandibular space. 

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