Anatomy Review. Main Structures Involved: Facial Bones of the Skull: -Maxilla, Mandible, and...
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Transcript of Anatomy Review. Main Structures Involved: Facial Bones of the Skull: -Maxilla, Mandible, and...
LOCAL ANESTHESIA FOR THE DENTAL HYGIENIST:
Anatomy Review
Main Structures Involved:Facial Bones of the Skull:
-Maxilla, Mandible, and Palatine bones
Cranial Nerve V—Trigeminal nerve:V2-Maxillary branch of the Trigeminal
nerveV3-Mandibular branch of the
Trigeminal nerve
Cranial NervesEmerge from the
inferior surface of the brain
All pass through the foramina (window like opening) of the skull to innervate structures in the head, neck, and facial region
Cranial Nerves (12 pairs)I- OlfactoryII- OpticIII- OculomotorIV- Trochlear
V- Trigeminal VI- AbducentVII- FacialVIII-VestibulocochlearIX- Glossopharyngeal X- VagusXI- Accessory XII- Hypoglossal
Trigeminal Nerve - V
Trigeminal NerveLargest cranial nerve/Most Important
Short trunk from brain with 2 roots
Afferent /Sensory Root [larger]
Has trigeminal ganglionOpthalmic V1Maxillary V2Mandibular V3
Motor /Efferent root [smaller]Muscles of masticationParasympathetic to
salivary glands
Cranial Nerve V (Trigeminal)3
Divisions/branches
• V1 entirely afferent
• V2 entirely afferent
• V3 mixed, both afferent and efferent
Foramen of the Trigeminal Nerve
V-1 Ophthalmic DivisionEnters the eye through the Superior orbital fissure
Sensation to conjuctiva, cornea, eyeball, orbit, forehead, ethmoid sinus, frontal sinus, dura mater of brain
V-2 Maxillary DivisionEnters the skull through
the Foramen Rotundum
Afferent (Sensory) nerve for:
Maxilla and overlying skin and dental plexus
Maxillary sinuses Nasal cavity Palate Nasopharynx Part of dura mater
V2 Branches:Infraorbital Nerve
Sensation for upper lip, medial cheek, lower eyelid and side of the nose
Passes through infraorbital sulcus (groove in floor of orbit) becomes:
Infraorbital canal which terminates at:
Infraorbital foramen
Sensation for Maxillary centrals, laterals, canines, and associated tissues
Originates in pulp tissues of teeth at apical foramen
Joins the infraorbital nerve along anterior wall of maxillary sinus
May cross over midline.
V2 Branches:Anterior Superior Alveolar (ASA)
V2 Branches:Middle Superior Alveolar (MSA)
Sensation for Maxillary premolars and mesiobuccal root of the 1st molar, and buccal gingiva.
Originates in pulp tissues of teeth at apical foramen
Joins the infraorbital nerve along lateral wall of maxillary sinus
Not present on all patients.
Communicates with ASA and PSA nerves.
V2 Branches:Posterior Superior Alveolar (PSA)
Sensation for Maxillary 1st (except MB root), 2nd, 3rd molars, buccal gingiva, and maxillary sinus.
Originates in pulp tissues of teeth at apical foramen
Joins the infraorbital nerve along lateral wall of maxillary sinus
Communicates with ASA and MSA nerves.
V2 Branches: Greater Palatine Nerve
Posterior hard palate and posterior lingual gingivaEnters Greater palatine foramen near 2-3rd molar
V2 Branches: Lesser Palatine NerveSoft Palate and palatine tonsillar tissuesEnters lesser palatine foramen near pterygoid
process
V2 Branches: Nasopalatine Nerve
Mucosa of anterior hard palate and lingual gingiva of maxillary teeth
Enters incisive foramen beneath incisive papillaTravels along nasal septumCommunicates with GP nerve lingual to the maxillary
canines
V-3 Mandibular DivisionEnters the skull through the
Foramen Ovale in Sphenoid boneLargest of three divisionsSensory root to:
CheekExternal ear and scalpTongueSubmand/Sublingual salivary
glandsFloor of the mouthMandibular dental plexus
Motor root to:Muscles of MasticationPalatal muscles
V3 Branches: Buccal NerveSkin of cheekBuccal mucosaBuccal gingiva of
mandibular posterior teeth
Located on surface of buccinator muscle
V3 Branches: Lingual Nerve
Lateral surface of the tongue
Slightly medial to Inferior alveolar nerve
Sensory for body of the tongue, floor of the mouth, and lingual gingiva of mandibular teeth
V3 Branches: Mental Nerve Sensory for chin, lower
lip, and labial mucosa of mandibular pre-molars, and anterior teeth
Merges with the incisive nerve to form the IA nerve
Enters the mental foramen on the anterior surface of the mandible near 1st and 2nd premolar apices
V3 Branches: Incisive Nerve
Sensory for mandibular premolars and anterior teeth pulp tissue
Merges with the mental nerve to form the IA nerve
May crossover midlineEnters the mental
foramen on the anterior surface of the mandible near 1st and 2nd premolar apices
V3 Branches: Inferior Alveolar Nerve Sensory for mandibular
teethFormed from merger of
the mental and incisive nerves
Exits the mandibular foramen on the lingual surface of the ramus
V3 Branches: Mylohyoid Nerve
Efferent (motor) for mylohyoid muscle and anterior belly of digastric muscle
May serve as a afferent nerve for mandibular 1st molar if IA nerve block failure