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Maxillary nerve block
Maxillary nerve block
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Anesthesia

  1. 1. 1- Intraoral techniques: a) Local infiltration of nerve endings (submucosal analgesia). b) Block of the terminal branches (infiltration anesthesia). c) Anterior and middle superior alveolar nerve block (infraorbital).
  2. 2. 1- Intraoral techniques: d) Posterior superior alveolar nerve block (zygomatic). e) Nasopalatine nerve block (incisive canal injection). f) Anterior (greater) palatine nerve block. g) Maxillary nerve block.
  3. 3. 2- Extraoral techniques: a) Anterior and middle superior alveolar nerve block (infraorbital). b) Maxillary nerve block.
  4. 4. Nerves anesthetized. Areas anesthetized. Anatomical landmarks. Indications. Technique. Symptoms of anesthesia: a) Subjective symptoms. b) Objective symptoms.
  5. 5. Basic Injection Technique  Position the patient  Communicate with the patient  Prepare the tissue  Dry the area  Apply antiseptic  Apply topical anesthetic  Check flow of local anesthetic
  6. 6. Maxillary Injection Techniques Nerve Block  Posterior superior alveolar nerve block  Middle superior alveolar nerve block  Anterior superior alveolar nerve block  Maxillary (second division) nerve block  Greater (anterior) palatine nerve block  Nasopalatine nerve block
  7. 7. Maxillary Anaesthesia  Maxillary bone is porous and mainly cancellous.  Roots of the maxillary teeth are covered only by a thin layer of buccal bone.  Highly vascular
  8. 8. Maxillary nerve distribution and LA • Infiltration A.: • Buccal Infiltration • Palatal Infiltration • Block A.: • Posterior superior alveolar NB • Middle superior alveolar NB • Infra orbital NB (Int. Ext. oral). • Greater Palatine NB • Nasopalatine NB • Maxillary NB (Int. Ext. oral).
  9. 9. Maxillary infiltration anaesthesia 1. Buccal Infiltration A.: • For all Maxillary teeth • Slow supraperiosteal injection • Opposite to the tooth apex, at a point made by the long axis of the tooth and the buccal vestibule • Needle bevel toward the bone • Onset is 3-5mn. and working time is 20 – 30 minutes.
  10. 10. .Maxillary labial infiltration A. 2 • Opposite to the tooth apex, at a point made by the long axis of the tooth and the labial vestibule
  11. 11. Palatal Anaesthesia ((infiltration & block  Nasopalatine nerve  infiltration  block  Greaterpalatine nerve  infiltration  block  No need for lesser palatine A.
  12. 12. Infiltration - Palate  Nerves  Terminal branches - Greater Palatine nerve  Nasopalatine nerve  Area  Palatal soft tissue in area of injection
  13. 13. Infiltration - Palate  Indications  Limited area  Hemostasis  Contraindications  More than 2 teeth  Inflammation/infection at site  Advantages  Hemostasis  Minimal area affected  Disadvantages  Potentially traumatic
  14. 14. Infiltration - Palate  Technique  Apply topical, pressure  Insert into gingiva in center of area  - 5-10 mm from gingival margin  Aspirate (positive results are rare)  Inject 0.2-.3 ml, slowly
  15. 15. Failures of Anesthesia  Quite rare  Failure of hemostasis  Inflammation  Lack of vasoconstrictor
  16. 16. Complications  Necrosis or sloughing of the palatal soft tissue (due to excess vasoconstriction)
  17. 17. Greeter palatine nerve block  Between upper 2nd and 3rd molars. Midway between the median palatine raphae and the free gingival margin.
  18. 18. Posterior superior nerve block Distal to the 2nd molar, posterior to the tuberosity, at 45 degrees  Aspirate first, Pterygoid plexus of veins. Maxillary N B Post. Sup. Alv.NB Maxillary infiltration
  19. 19. Posterior Superior Alveolar Nerve Block  Nerve Anesthetized:  Posterior Superior Alveolar Nerve (PSA)  For maxillary molars and buccal tissue
  20. 20. Indications for PSA Block  First or second maxillary molar  Supraperiosteal injection has proved ineffective  Contraindication  Risk of hemorrhage is too great  (eg. hemophilia, coumadin)

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