Home Page Essay samples WWA#4; DH 20; Ch. 12, Maxillary Nerve Anesthesia (supraperiosteal, PSA, MSA, ASA) Essay Example

WWA#4; DH 20; Ch. 12, Maxillary Nerve Anesthesia (supraperiosteal, PSA, MSA, ASA) Essay Example

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Pages: 6 (1582 words)
Published: July 7, 2018

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most local anesthesia of the maxilla is more successful than that of the mandible because

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the facial plate of the maxillary bone over maxillary teeth is less dense than

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less anatomic variation of the maxillary and palatine bones and nerves with respect to anatomic landmarks than there is in similar mandibular structures

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so maxillary injections more routine, usually without need for troubleshooting failures

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VAS of maxillary facial injections

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0-2

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no bony contact

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except at final deposition point of IO

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to increase patient comfort during maxillary facial injections

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needle should not be moved within tissue, nor should patient's upper lip be shaken

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to reduce patient discomfort

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agent should be deposited slowly and topical anesthesia used

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pulpal anesthesia of maxillary blocks achieved through

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anesthesia of each tooth's dental branches as the extend into the pulp by way of apical foramen --interdental and interradicular branches

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supraperiosteal injection

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for pulpal anesthesia on a limited number of teeth or when anesthesia of periodontium needed in localized area

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PSA block

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for anesthesia of maxillary molar teeth and assoc periodontium and buccal soft tissue in one quadrant

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MSA

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for anesthesia of maxillary premolars and assoc periodontium and buccal soft tissue in one quadrant

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ASA

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for anesthesia of maxillary canine and incisors and assoc periodontium and buccal soft tissue in one quadrant

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IO block

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for anesthesia of maxillary anterior and premolar teeth and assoc periodontium as well as facial tissue in one quadrant

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if either sextant or quadrant treatment is planned on maxillary arch,

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the PSA block is given before any of the other maxillary facial injections as well as any maxillary palatal injections to allow the necessary time for the larger molars to become completely anesthetized --instrumenting proceeding in the same manner

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after PSA block, give

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MSA, then ASA, or IO block instead

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for half mouth treatment

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IA and buccal blocks given first, then the maxillary facial and then palatal injections, with instrumenting first on the maxillary arch

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local anesthesia should only be administered

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in areas of treatment that can be completed in one visit

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palpating injection site with a cotton tip applicator before the injection helps

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determine needle access problems -- like exostoses or bulky facial alveolar ridge

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supraperiosteal injection/local infiltration/field block

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for any tooth of

either arch --anesthetizes terminal fibers in maxillary arch because bone more porus

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SI especially useful for

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hemostasis in smaller circumscribed area, like during maintenance or recare appt.

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terminal branches of selected tooth or teeth and facial or lingual soft tissue, 27 short, mucobuccal fold or lingual surface at apex of selected teeth at height of mucobuccal fold or lingual surface, 5 mm or 1/4 of short needle, 0.6 mL or 1/3 of cartridge, 30-60 sec; aspiration potential < 1%

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if infection present,

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do nerve block instead

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SI not recommended when

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several teeth in quad need to be anesthetized; use nerve block instead

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deposit location/target area

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apex of selected tooth --root lengths vary

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needle insertion point/injection site

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height of maxillary arch or depth of mucobuccal fold or lingual/palatal surface, with needle inserted toward bone --no bony contact

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PSA block indicated when

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procedure involves 2 or more molars or their associated periodontium and buccal gingival tissue

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PSA nerve and areas anethetized

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PSA nerve, molars completely in 72% of population, and mesiobuccal root of max first molar not anesthetized in 28% --also buccal soft tissue of maxillary molar region

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PSA needle

and operator position

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25 short prefered, but 27 acceptable; right 8 or 9:00, left 10:00

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PSA landmarks

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maxillary tuberosity, maxillary mucobuccal fold, maxillary 2nd molar, maxillary occlusal plane, midsaggital plane

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PSA needle insertion point and depth

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at height of mucobuccal fold superior to apex of maxillary 2nd molar; 16 mm or 3/4 depth of short needle

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PSA deposit location, amount of anesthetic and time

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superior to apex of maxillary 2nd molar and posterior and superior to posterior border of maxilla at PSA foramina, --0.9 - 1.7 mL or one-half to full cartridge; 60-120 seconds

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If mesiobuccal root 1st molar not innervated by PSA,

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give MSA as well

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maxillary molars often first to be involved in periodontal disease

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so consider this block during quad NSPT and also during maintenance and recare appointments

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if anesthesia of lingual or palatal soft tissue is also needed

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give greater palatine block as well

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target area for PSA

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PSA nerve as it enters maxilla through the PSA foramina on the maxilla's infratemporal surface; -- posterosuperior and medial on the maxillary tuberosity

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needle depth with smaller and larger skulls

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16 mm, or 3/4 the depth of short needle

should not vary much on average size; --decrease depth if smaller to lessen risk of hematoma --to decrease risk of hematoma on a large patient, still use 25-short

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to achieve visability for needle insertion

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retract alveolar mucosa vertically about 1 cm distal to the zygomatic process so that the distal part of the maxillary tuberosity is exposed --a concavity in mucobuccal fold distal to maxillary tuperosity will be present

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overall angulation of needle to injection site

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45 degree angle to occlusal plane, inward at 45 degree to occlusal plane, and backward or posteriorly from midsaggital plane at 45 degree angle to long axis of maxillary 2nd molar

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when attempting nondominant side

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needle should follow same pathway as the nondominant arm, --always toward surface of maxilla and operator's body

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in order to accomplish needle angulations

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no bending of needle shank, no movement of needle within tissue to obtain correct angulation

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usually no indications of successful PSA

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so patient has difficulty determining extent of anesthesia; --lip and tongue do not feel numb --teeth feel dull when gently tapped --absence of pain during dental procedures

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no bone contact at any time!

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if bone is contacted, or resistance felt, angle of needle toward midline is too great; mover syringe closer to occlusal plane

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class="flashcard__q">if needle advanced too far distally into tissue

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may penetrate pterygoid plexus and maxillary artery, possibly causing a hematoma

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hematoma

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bluish-reddish extraoral swelling of hemorrhaging blood in the tissue

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if needle is additonally contaminated

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may be spread of infection to cavernous sinus

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positive aspiration potential

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3.1%; third highest; aspirate several times within different planes --do not give on children

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avoid depositing lateral to PSA nerve to prevent

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harmless and inadvertant mandibular anesthesia

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MSA block for

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maxillary premolars and mesiobuccal root of maxillary first molar --most clinicians give this block even though MSA nerve absent in 68% of population --to ensure coverage of mesiobuccal root of 1st molar

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MSA anesthetizes

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pulp only; need greater palatine for lingual or palatal soft tissue of these teeth

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MSA needle

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27-short

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MSA operator position

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right 8:00, left 9:00

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MSA landmarks

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maxillary mucobuccal fold, maxillary second premolar

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MSA target area

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MSA nerve at apex of maxillary second premolar

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MSA needle insertion point

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at height of mucobuccal fold

at apex of maxillary 2nd premolar, inserted until tip is located superior to the apex of maxillary second premolar without resistance or bony contact in order to reduce trauma

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because root length varies among patients,

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depth of needle penetration will vary --5 mm, or 1/4 the depth of short needle

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if one of maxillary premolars has been removed for othro therapy, existing premolars move from their original place

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estimate target area by having injection site halfway in the dental arch to provide best anesthetic coverage to maxillary premolars

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pulling upper lip more anteriorly helps avoid having to go through large frena

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if not able to avoid frena, give injection slightly posterior than anterior to the recommended site for more complete coverage

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indications of a successful MSA block

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harmless tingling and numbing of upper lip and absence of discomfort

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positive aspiration for MSA

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less than 3.1%

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amount of anesthetic for MSA

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0.9 - 1.2 mL or 1/2 to 2/3 of cartridge

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amount of time for MSA

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60-90 seconds

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crossover innervation

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when ASA nerve crosses the midline to the contralateral side of patient --bilateral injections may be indicated

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ASA area

anesthetized

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pulp of maxillary canine and incisor teeth, associated periodontium and facial soft tissue --need nasopalatine block for lingual anesthesia

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ASA target area

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ASA nerve at apex of maxillary canine

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ASA needle

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27-short

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ASA operator position

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right 8:00, left 9:00

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ASA landmarks

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canine eminence, canine fossa, maxillary mucobuccal fold, maxillary canine

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ASA injection site

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height of mucobuccal fold at apex of maxillary canine, just anterior to and parallel with canine eminence and approximately 10 degree angle off an imaginary line drawn parallel to long axis of tooth; --just over the canine fossa located anterior to canine eminence

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ASA needle tip placed

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superior to apex of maxillary canine without resistance or bony contact

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ASA depth of penetration

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5 mm or 1/4 the depth of short needle --root lengths vary

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ASA aspiration potential

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less than 1%

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ASA amount of anesthetic

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0.6 - 0.9 mL or 1/3 to 1/2 of cartridge

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ASA amount of time

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30-60 seconds

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ASA indications of successful block

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harmless numbing

and tingling of upper lip, absence of discomfort

WWA#4; DH 20; Ch. 12, Maxillary Nerve Anesthesia (supraperiosteal, PSA, MSA, ASA) Essay Example

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