maxillary nerve blocks

DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

Presented by –ABHIJEET KAMBLEFINAL YEAR

Maxillary nerve blocks

• Seminar on -

Opthalmic division V1

Maxillary nerve V2

Mandibular nerve V3

www.themegallery.com

Techniques of Maxillary Anesthesia


Types of InjectionsI. Supraperiosteal (infiltration)II. Periodontal ligament (PDL, intraligamentary)III. Intraseptal injectionIV. Posterior superior alveolar nerve blockV. Middle superior alveolar nerve blockVI. Anterior superior alveolar nerve blockVII. Greater (anterior) palatine nerve blockVIII. Nasopalatine nerve blockIX. Maxillary (second division) nerve blockX. Anterior meddle superior alveolar nerve blockXI. Palatal approach-anterior superior alveolar n block


Supraperiosteal Injection


Nerves anesthetized– terminal branch of dental plexusAreas anesthetized

Entire region innervated by the large terminal branches of this plexus

Indications1. Pulpal anesthesia of maxillary teeth when treatment is limited

to 1 or 2 teeth2. Soft tissue anesthesia when indicated for surgical procedure

Contraindications1. Infection or acute inflammation2. Dense bone covering the apices of teeth


Advantages1. High success rate (>95%)2. Easy & usually entirely atraumatic

Disadvantages Not recommended for larger areas because of multiple

injectionAlternatives– PDL, IO, regional blockAnatomical landmark:

Mucobuccal fold Crown of the tooth Root contour of the tooth


Technique1. Lift the lip, pulling the tissue taut2. Hold the syringe parallel to the long axis of the tooth3. Insert the needle at the height of the mucobuccal fold over the

target tooth4. Advance the needle until its bevel is at or above the apical

region of the tooth5. Aspirate, if –ve , deposit 0.6 ml slowly over 20 seconds

Sighs & symptoms1. Subjective: feeling of numbness in the area of administration2. Objective: no pain during therapy


Safety features1. Minimal risk of intravascular administration2. Slowness of injection, aspiration

Precautions should not be used for larger areas

Complications pain on needle insertion with the tip against

periosteum


Posterior superior alveolar nerve block Posterior superior alveolar nerve block


Nerves Anesthetized- Posterior superior alveolar

and its branchesAreas Anesthetized-

1) Pulps of the maxillary 3rd , 2nd and 1st molars

2) Buccal periodontium and bone overlying these teeth

Anatomical Landmarks-1. Mucobuccal fold and its

concavity2. Zygomatic process of the

maxilla3. Infratemporal surface of the

maxilla4. Anterior border and coronoid

process of the ramus of the mandible

5. Maxillary tuberosity


Anterior superior alveolar(ASA) nerve block


3. Buccal(labial) periodontium and bone of these teeth

4. Lower eyelid, lateral aspect of the nose, upper lip

Anatomical landmarks1. Infraorbotal notch2. Infraorbital

depression 3. Infraorbital ridge4. Supraorbital notch5. Anterior teeth6. Pupils of eye


Middle Superior Alveolar Nerve Block


Nerves anaesthetizedMSA & terminal branchAreas anaesthetized

1. Pulps of maxillary 1st & 2nd premolar & mesiobuccal root of 1st molar(28%)

2. Buccal periodontal tissues & bone of these teeth

Anatomical landmarks Mucobuccal fold above the

maxillary 2nd premolarAdvantages– minimizes no. of

injection & volume of solution


Greater palatine nerve block


Nasopalatine Nerve Block


TechniqueTwo types of technique– 1.single

penetration2. multiple penetrationTechnique-1 (single)

1. Area of insertion– palatal mucosa just lateral to the incisive papilla

2. Target area– incisive foramen beneath the papilla

3. Path– approach the injection site at 45 degree angle toward the papilla

4. Chair position– 9 or 10 o’clock position facing in the same direction as the patient

5. Slowly advance the needle towards the foramen until bone is gently contacted (depth approx. 5 mm)

6. Slowly deposit 0.45 ml in 15-30 second minimum


3. Procedure4.

a) 1st injection: retract the upper lip to stretch tissues & improve visibility. Gently insert in the frenum & deposit 0.3 ml in approx. 15 seconds

b) 2nd injection: at 11 or 12 o’clock position, tilting the patients head in the right, & needle at right angle to interdental papilla needle is inserted into the papilla just above the level of crestal bone. Aspirate when ischemia is noted in the incisive papilla or needle tip become visible just beneath the tissue surface

Signs & symptoms1. Subjective: numbness in the upper lip & anterior

portion of the hard palate2. Objective: no pain therapy

Safety features1. Aspiration 2. Contact with bone


Maxillary nerve block


Alternatives1. PSA nerve block2. ASA nerve block3. GP nerve block4. Nasopalatine nerve block

Technique– 2-type: high tuberosity approach & GP canal approach

High-tuberosity approach1. Area of insertion– height of

mucobuccal fold above the distal aspect of 2nd molar

2. Target area– maxillary n. as it passes through the pterygopalatine fossa

• superior and medial to the target area of PSA n. block


Anterior middle superior alveolar nerve block


Advantages1. Provides anesthesia of multiple teeth

with single injection2. Minimizes volume of anesthesia & no. of

puncture3. Allows effective soft tissue & pulpal

anesthesia for periodontal scaling 7 root planing

4. Allows accurate smile line assessment5. Eliminates postoperative inconvenience

of numbness to the upper lip & muscle of facial expression

6. Can be perform comfortably with a CCLAD

Disadvantages1. Requires a slow administration time ( 0.5

ml/min)2. Can cause operator fatigue with a

manual syringe3. May need supplemental anesthesia for

C.I. & L.I.

maxillary nerve blocks

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