Local anesthesia – maxillary – Flashcards
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What foramen does maxillary division of trigeminal nerve come through?
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Foramen rotundum
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Branches of V1 of trigeminal nerve?
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Nasociliary nerve * Posterior ethmoidal nerve Long ciliary nerve Infratrochlear nerve Anterior ethmoidal nerve Lacrimal nerve * Frontal nerve * Supratrochlear nerve Supraorbital nerve
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Is opthalmic division of trigeminal nerve sensory or motor?
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Sensory
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What does opthalmic division of trigeminal nerve supply?
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Eyeball, conjunctiva, lacrimal gland, mucus membrane of nose and paranasal sinuses, and skin of forehead, eyelid, and nose
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What groups can the branches of the maxillary nerve be divided into?
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In the cranium In the pterygopalatine fossa In the infraorbital canal On the face
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What branches are found in the cranium?
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Middle meningeal nerve in the meninges
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What branches are found in the pterygopalatine fossa?
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Zygomatic nerve (zygomaticotemporal and zygomaticofacial) Nasal branches (nasopalatine) Superior alveolar nerves (posterior and middle) Palatine nerves (greater and lesser) Infraorbital nerve Pharyngeal nerve
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Where does zygomaticofacial nerve go through?
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Inferior orbital fissure
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What foramen does nasopalatine go through?
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Sphenopalatine foramen
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Where does infraorbital nerve go through?
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Infraorbital canal
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What branches are found in the infraorbital canal?
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Anterior superior alveolar nerve Middle superior alveolar nerve Infraorbital nerve
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What branches are found on the face?
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Inferior palpebral nerve Superior labial nerve Lateral nasal nerve
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What does anterior superior alveolar nerve branch of maxillary nerve supply?
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Cantral and lateral incisors Canine PDL, buccal bone, mucous membrane of these teeth
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What are the three types of maxillary nerve blocks?
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Posterior superior alveolar nerve block Middle superior nerve block Anterior superior nerve block (Infraorbital nerve block) Incisive nerve block Greater palatine nerve block Second divisions nerve block
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Site of injection for posterior superior alveolar nerve block?
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Insert at height of vestibule, insert 16mm depth...lateral to max molar
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Areas anesthetized by PSA nerve block?
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Maxillary molar tooth pulps MB root of 1st molar (72%) Buccal periodontium and bone
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What are the advantages of PSA nerve block?
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Atraumatic Success rate >95% Minimal volume of anestetic
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What are the disadvantages of PSA nerve block?
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Disfiguring hematoma risk MB root of 1st molar missed in 28% Aspiration rate ~3%
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Injection technique to perform MSA nerve block?
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Well above premolar apices, bevel facing bone
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Areas anesthetized by MSA nerve block?
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Premolars MB root of first molar 28% Buccal periodontium and bone
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Indications for MSA nerve block?
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To treat both premolars When a nerve block is indicated When supraperiosteal injection has failed When infraorbital block does not anesthetize premolars
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Injection technique to perform Anterior superior alveolar nerve block?
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Locate foramen (~16mm above vestible) Insert half of long needle (bevel towards bone), needle contacts roof foramen and anesthetic is directed into canal through direct pressure for 1 min. after injection
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What areas are anesthetized by ASA nerve block?
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Maxillary central through canine Premolars MB root of first molar in 28% of patients Buccal periodontium and bone Lower eyelid, side of nose, upper lip
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Indications for ASA nerve block?
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2+ teeth Inflammation or infection Dense cortical bone making supraperiosteal injections ineffective
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Where is the injection site for supraperiosteal nerve block?
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Anesthetic is placed apical to apex...insert needle superior to root apex (bevel towards bone)
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Areas anesthetized by supraperiosteal injection?
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Tooth Bucccal periodontium and bone Labial or buccal mucosa
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Indications for supraperiosteal injection?
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Procedures on one tooth Soft tissue surgery in a small area
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Advantages of supraperiosteal injection
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Simple High success rate
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Disadvantages of supraperiosteal injection
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Not useful in inflamed area Large volumes needed to treat multiple teeth
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Path of insertion for greater palatine nerve block
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Place needle bevel against tissue and bow needle towards greater palatine foramen...straighten and advance the needle
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What areas are anesthetized by the greater palatine nerve block?
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Posterior portion of hard palate Overlying soft tissues No anesthesia of teeth
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What are the indications for the greater palatine nerve block?
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When palatal soft tissue anesthesia is needed - extractions, subgingival restorations, etc. Pain control during periodontal or oral surgical procedures
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2 different paths of insertion of nasopalatine nerve block?
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Lateral to papilla (behind max anterior) Through papilla towards palate (trans papillary)
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Areas anesthetized by nasopalatine nerve block
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Anterior portion of hard palate Both hard and soft tissues No anesthesia of teeth
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What are the indications for the nasopalatine injection?
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When palatal soft tissue anesthesia is needed - extractions, subgingival restorations, etc. Pain control during periodontal or oral surgical procedures
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Where do you inject second division nerve block (maxillary nerve block) for a high tuberosity approach?
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Lateral to max molars (really high)
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Advantages of maxillary nerve block high tuberosity approach?
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Atraumatic 95% success rate Minimizes volume of local
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Disadvantages of maxillary nerve block high tuberosity approach?
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Risk of hematoma Absent bony landmarks Lack of hemostasis
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Where do you inject second division nerve block (maxillary nerve block) for a greater palatine canal approach?
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Lateral part of roof of mouth through greater palatine canal
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Advantages of maxillary nerve block greater palatine canal approach?
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Usually atraumatic 95% success rate Minimizes volume of local
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Disadvantages of maxillary nerve block greater palatine canal approach?
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Lack of hemostasis Potentially painful injection
