Bony Landmarks of the Skull for Local Anesthesia.
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What skull bones are involved in local anesthesic administration?
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Maxillae, palatine bones, and mandible
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To increase the reliability of local anesthesia, what must the DH learn to rely on?
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Visualization and palpation of bony landmarks while injecting patients
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What are the prominences and depressions on the bony surface of the skull landmarks for?
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Attachments of associated muscles, tendons, and ligaments as well as for the administration of local anesthesia
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What is the general term for any prominence on a bony surface?
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A process
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What prominence located on the bony surface is usually involved in joints?
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Condyle
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What is a large often rough prominence?
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Tuberosity
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What is a straight small ridge?
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Line
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What is a type of depression on the bone, an indentation at the edge of the bone?
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Notch
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What is a generally deeper depression on a bony surface?
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Fossa
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What are the openings in the bone landmarks for?
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Various nerves and blood vessels, where they enter or exit, which is important when administering local anesthesia
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What is a foramen?
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A short windowlike opening in the bone
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What is a canal?
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A longer narrow tubelike opening in the bone
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What does the maxillae consist of?
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Paired maxilla or maxillary bones that are fused together at the intermaxillary suture
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What does each maxilla consist of?
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A body and four processes: frontal, zygomatic, palatine, and alveolar
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What are the four processes of the maxilla?
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frontal, zygomatic, palatine, and alveolar
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What surfaces does the body of the maxilla have?
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Orbital, nasal, infratemporal, and facial
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What do the bodies of the maxilla contain?
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Air filled spaces or paranasal sinuses (maxillary sinuses)
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What does each frontal process of the maxilla articulate with?
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Frontal bone
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What forms the medial orbital rim?
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Frontal process with the lacrimal bone on its anterior surface
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What is the orbital surface of the maxilla separated from the sphenoid bone by?
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Inferior orbital fissue
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What does the inferior orbital fissure carry?
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Infraorbital and zygomatic nerves, infraorbital artery, and inferior ophthalmic vein
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What is the groove in the floor of the orbital surface?
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Infraorbital sulcus
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What does the infraorbital sulcus become?
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Infraorbital canal
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Where does the infraorbital canal terminate?
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On the facial surface of each maxilla as the infraorbital foramen
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What does the infraorbital foramen transmit?
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Infraorbital nerve and blood vessels
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What will palpitation of the infraorbital foramen cause?
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Soreness on the patient
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What is the infraorbital foramen a landmark for?
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Administration of the infraorbital block
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What is inferior to the infraorbital foramen?
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An elongated depression called the canine fossa
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Where is the canine fossa?
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Posterosuperior to the roots of the maxillary canine tooth
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What is each tooth of the maxillary arch covered by?
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A prominent facial ridge of the bone, a part of the alveolar process of the maxilla
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What is the facial ridge over the maxillary canine?
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canine eminence
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What is the canine eminence a landmark for?
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Administration of the anterior superior alveolar block
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Why would there be a greater incidence of clinically adequate local anesthesia for the maxillary teeth when the local anesthetic agent is administered as a supraperiosteal injection or local infiltration than would occur with similar teeth on the mandibular arch?
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Because the maxillary bone over the facial surface of the maxillary teeth is less dense and more porous than the mandibular bone over similar teeth
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from the lateral view, what does the zygomatic process of the maxilla articulate with?
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The zygomatic bone
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What completes the infraorbital rim?
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Zygomatic process of the maxilla and the zygomatic bone
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What is a rounded roughened elevation located posterior to the most distal molar of the maxillary dentition?
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Maxillary tuberosity
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What is the superolateral part of the maxillary tuberosity perforated by?
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One or more posterior superior alveolar foramina
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What goes through the posterior superior alveolar foramina?
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Posterior superior alveolar nerve and blood vessel branches, which enter from the back of the bone
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What are the maxillary tuberosity and posterior superior alveolar foramina landmarks for?
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Administration of the posterior superior alveolar block
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What does each palatine process of the maxilla articular with the other to form?
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The anterior part of the hard palate
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What is the suture between the two palatine process?
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The anterior part of the median palatine suture
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What is the median palatine suture covered by?
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The median palatine raphe
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What is the median palatine raphe a landmark for?
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Administration of the anterior middle superior alveolar block
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What is located between the two articulating palatine processes of the maxillae just posterior to the maxillary central incisor?
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Incisive foramen
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What does the incisive foramen carry?
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Both branches of the right and left nasopalatine nerves and blood vessels from the nasal cavity to the palate
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What is the incisive foramen and incisive papilla both landmarks for?
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The administration of the nasopalatine block
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What does the alveolar process of the maxilla usually contain?
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Roots of the maxillary teeth
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What are landmarks for the administration of most of the maxillary injections?
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The apices of the roots of the maxillary teeth on both the facial and lingual surface of the maxillary alveolar process
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When can the maxillary alveolar process become resorbed?
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If a patient is completely edentulous in the maxillary arch
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Although the superior body of the maxilla is not resorbed with bone loss, what happens instead?
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Walls may become thinner
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What does the palatine bone consist of?
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Paired bones that are made of two plates: horizontal and vertical
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Where can the horizontal and vertical plate of the palatine bone be viewed?
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On the posterior view of the palatine bone
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What does the horizontal plate of the palatine bone form?
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Lesser or posterior part of the hard palate
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What does the vertical plate of the palatine bone form?
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A part of the lateral walls of the nasal cavity, and each plate contributes a small lip of bone to the orbital apex
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What does the palatine bones serve as a link between?
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Maxillae and sphenoid bone with which they articulate, as well as with each other
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What do the two horizontal plates articulate with?
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Each other at the posterior part of the median palatine suture and with the maxillae at the transverse palatine suture
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What are two important foramina in the palatine bones?
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The greater and lesser palatine foramina
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Where is the larger greater palatine foramina located?
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Posterolateral region of each of the palatine bones, usually at the apex of the third molar
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What does the great palatine foramina transmit?
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Greater palatine nerve and blood vessels
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What is the greater palatine foramina landmark for?
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Administration of greater palatine block
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What does the lesser palatine foramen transmit?
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Lesser palatine nerve and blood vessels to the soft palate and tonsils
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Why is the lesser palatine nerve sometimes inadvertently become anesthesized with the greater palatine block?
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Because of the close proximity to the greater palatine foramen and its nerve, making patient uncomfortable as their soft palate becomes anesthesized
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What serves as openings of the pterygopalatine canal?
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Both the greater palatine foramen and lesser palatine foramen
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What is carried in the pterygopalatine canal?
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Descending palatine nerves and blood vessels from the pterygopalatine fossa to the palate
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What is the only freely moveable bone of the skull?
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Mandible
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What does the mandible have a moveable articulation with?
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temporal bones at each temperomandibular joint
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What does the mandible also articulate with?
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Both of the maxilla by way of their contained respective lower and upper dental arches
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Where is the mental protuberance of the chin located?
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Deep to the roots of the mandibular incisor
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What is the mandibular symphysis?
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Located in the midline on the anterior surface of the mandible; faint ridge where the bone is formed by the fusion of the right and left processes
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What is the mental foramen?
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An opening located between the apices of the mandibular first and second premolars
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What does the mental foramen allow the entrance of?
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Mental nerve and blood vessels into the mandibular canal
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What is an important landmark to note intraorally and on a radiograph before administration of both mental and incisive blocks?
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Mental foramen
