Technique of maxillary anesthesia which includes Greater Palatine Nerve Block and Incisive Nerve Block. The reference is of LA Book by Malamed. Hope you find it useful. Please like and share.

1. Technique of Maxillary
Anesthesia
Palatal Anesthesia I
1.Greater Palatine
2.Naso-Palatine (Incisive)
Anumesh Dahal
BPKIHS, Nepal

2. Maxillary Anesthesia Techniques
• Supraperiosteal infiltration
• Periodontal ligament
• Intraseptal injection
• Intraosseous (IO) injection
• Intracrestal Injection
• Posterior Superior Alveolar Nerve
Block (PAS)
• Anterior Superior Alveolar Nerve
Block (ASA)
• Middle Superior Alveolar Nerve
Block (MSA)
• Greater Palatine Nerve Block (GP)
• Nasopalatine Nerve Block (NP)
• Posterior- Anterior Superior Alveolar
Nerve Block (P-ASA)
• Anterior Middle Superior Alveolar
Nerve Block (AMSA)
• Maxillary(V2) Nerve Block

3. Palatal Anesthesia
• Greater Palatine Nerve Block (GP)
• Nasopalatine Nerve Block (NP)
• Posterior- Anterior Superior Alveolar Nerve Block (P-ASA)
• Anterior Middle Superior Alveolar Nerve Block (AMSA)
• Maxillary(V2) Nerve Block

4. Before Palatal Anesthesia
• Manipulation of the hard and soft tissue only – no
pulpal anesthesia
• Traumatic
• Topical anesthesia
• Pressure anesthesia
• Control over the needle
• Slow Deposition

5. Greater Palatine Nerve Block (GP)
Amount of LA deposited 0.45 – 0.6 ml
Depth of Penetration Until bone hit ~ 5mm
Positive Aspiration < 1 %
Nerve Anesthetized Greater Palatine
a.k.a. Anterior Palatine Nerve Block

6. Landmarks
1. Greater palatine foramen
2. Junction of alveolar process
and palate
Locate Greater Palatine
foramen:
GP foramen lies (90% of
times) medially to the region
between 2nd and 3rd Maxillary
Molar
Greater Palatine Nerve Block (GP)
X

7. Greater Palatine Nerve Block (GP)
X

9. Greater Palatine Nerve Block (GP)
Area anesthetized
• Posterior portion of hard palate &
overlying soft tissue
• Anteriorly till 1st Premolar
• Medially till midline
• Subjective Sign: numbness on
the posterior part of hard palate
• Objective Sign: no pain during
treatment
Remember
This block is for the tissues
of the palate not for the
pulpal anesthesia

10. Complications
1. Palatal Necrosis d/t deposition
of Concentrated vasoconstrictor
2. Hematoma Formation
3. Patient may feel uncomfortable – due to presence of middle palatine
nerve at injection site
Greater Palatine Nerve Block (GP)

11. Nasopalatine Nerve Block (NP)
a.k.a. Incisive nerve block, Sphenopalatine nerve block
Amount of LA deposited 0.45 ml
Depth of Penetration Until bone hit ~ 5mm
Positive Aspiration < 1 %
Nerve Anesthetized Nasopalatine nerve bilaterally

12. Nasopalatine Nerve Block (NP)
X
Caution
• Extremely painful – inform the
patient
• You may penetrate into the
foramen and to the floor of nose
Landmarks
1. Central Incisors
2. Incisive Papilla

14. Nasopalatine Nerve Block (NP)
Area anesthetized
Anterior portion of the hard palate
bilaterally from mesial of the right
first premolar to the mesial of the
1st Premolar
• Subjective Sign: numbness on
the anterior part of hard palate
• Objective Sign: no pain during
treatment

15. Complications
• Squirting back of the LA
• Hematoma
• Necrosis
Nasopalatine Nerve Block (NP)