MAXILLARY NERVE BLOCK LOCAL ANESTHESIA

2. Techniques of
Maxillary nerve block…
By
Dr DAVIS NADAKKAVUKARAN
ASSTITANT PROFESSOR
Dept. of OMFS MDC MANOOR

3. NERVE BLOCK
LA deposited close to the main nerve trunk usually at
distance from the site of operative intervention.

4. FIELD BLOCK
Local anaesthetic solution is deposited near the larger
terminal branch, so the anaesthetized area will be
circumscribed.Treatment is done in an area away from
the site of injection

5. LOCAL INFILTRATION
Small terminal nerve endings in the area of dental
treatment are flooded with local anesthetic solution.
Treatment is done in the same area of in which solution
has been deposited.

6. MAXILLARY INJECTION
TECHNIQUES

7. SUPRA PERIOSTEAL
INJECTION:
( Local Infiltration )
INDICATIONS:
• Pulpal anesthesia of maxillary teeth when treatment is
limited to one or two tooth .
• Soft tissue anesthesia for surgical procedure in a
circumscribed area.

8. TECHNIQUE: needle is injected beneath the mucous
membrane & the solution is infiltrated slowly throughout the
area.
AMOUNT TO BE DEPOSITED- 0.6ml over 20 sec.
CONTRAINDICATION:
• Infection or acute inflammation in the area of injection.
DISADVANTAGES:
• Need for multiple needle insertions.
• Necessary to administer large volume of solution.

9. TECHNIQUES OF NERVE BLOCK

10. INTRA ORAL
TECHNIQUES

11. POSTERIOR SUPERIOR
ALVEOLAR NERVE BLOCK:
OTHER NAMES:
• Tuberosity block / Zygomatic block
AREAS ANAESTHETIZED:
• Pulps of maxillary III,II and I molar except mesio buccal root
of I molar.
• Buccal periosteum and bone overlying the teeth.

13. LAND MARKS:
• Mucobuccal fold.
• Zygomatic process of maxilla.
• Infra temporal surface of maxilla.
• Anterior border & coronoid process of the ramus of the mandible.
• Tuberosity of maxilla.
TECHNIQUE:
• PATIENT POSITION- pt is positioned such that maxillary occlusal plane is
45 degree angle to the floor.
• 25 gauge short needle is used.
• Insertion- height of mucobuccal fold above the maxillary II molar.

14. • The operators left forefinger over the muccobuccal fold in a
post direction from the bicuspid area until the zygomatic
process of maxilla is reached
• At its post surface finger will feel a concavity in the
mucobuccal fold. Then rotate the finger so that the fingernail is
adjacent to the mucosa, & its bulbous portion still in contact
with the posterior surface of the zygomatic process.
• Now needle is held in pen grasp & inserted in a line parallel
with the index finger, going UPWARD INWARD &
BACKWARD ( this places the needle in the immediate vicinity
of the foramen through which the nerves enter the maxilla).

15. • SYMPTOMS-
a) OBJECTIVE- instrumentation necessary to demonstrate
absence of pain.
b) SUBJECTIVE- None.

18. DEPTH OF NEEDLE PENETRATION-16 mm.
DEPOSIT:- 0.9 to 1.8 ml in 30 to 60 sec .
COMPLICATIONS:
• Hematoma

19. OTHER NAME:
• Infra orbital.
AREAS ANAESTHETIZED:
• Incisors, cuspids, bicuspids & mesiobuccal root of 1st
molar.
• Upper lip
• Lower eye lid.
• Portion of the nose of the
injected site.

21. ANATOMICAL LANDMARKS:
• Infra orbital ridge.
• Infra orbital depression.
• Supra orbital notch.
• Infra orbital notch.
• Bicuspid teeth.
• Mental foramen.
• Pupil of the eyes.
An imaginary straight line drawn vertically through these
landmarks will pass through the pupil of the eye, infraorbital
foramen(when the infraorbital notch is located, the palpatating
finger should be moved downward about 0.5mm, where a
shallow depression will be felt), bicuspids, & mental foramen.

22. • Maxillary occlusal plane at 45degree to the floor
• NEEDLE PATHWAY
BICUSPID APPROACH- The needle is inserted in a line
parallel with the supraorbital notch, the pupil of the eye,infra
orbital notch, & 2nd biscuspid tooth
CENTAL INCISOR APPROACH- The neeedle bisects the
crown of the central incisor from the mesioincisal angle to the
distogingival angle.
In either situatin, the needle should not penetrate more than ¾
inch, it prevents the needle from entering the orbital cavity

23. TECHNIQUE:
• NEEDLE- 25 gauge needle.
• SOLUTION DEPOSITED- 0.9 to 1.5 ml.
SYMPTOMS-
SUBJECTIVE- Tingling & numbness of the upper lip,
side of the nose
OBJECTIVE- instrumentation necessary to demonstrate
absence of pain.
COMPLICATION:
• Hematoma.
• Facial nerve paralysis.

26. GREATER PALATINE NERVE BLOCK:
OTHER NAME:
• Anterior palatine nerve block
AREAS ANAESTHETIZED:
• Posterior portion of hard palate and its over lying soft
tissues.
• Anteriorly up to I premolar and medially up to midline.

27. ANATOMICAL LANDMARKS:
• II and III maxillary molars.
• Palatal gingival margin of II and III maxillary molar.
• Midline of the palate.
• Line approximating 1cm from the palatal gingival
margin towards midline of the palate.
TECHNIQUE:
• NEEDLE- 25 gauge needle.
• INSERTION- From the opposite side of the mouth at
right angles to the target area.
• DEPOSITION-0.25 to 0.5 ml in 30 sec.

29. NASO PALATINE NERVE BLOCK:
OTHER NAMES:
• Incisive nerve block.
• Spheno palatine nerve block.
AREAS ANAESTHETIZED:
• Anterior portion of hard palate from mesial of Rt. I
premolar to mesial of the Lt.I premolar.
LANDMARKS:
• Central incisors
• Incisive papilla.

31. TECHNIQUE:
• INSERTION- At a 45 degree angle towards incisive
papilla.
• OPERATOR- In 9 or 10 o’ clock position.
• DEPOSIT- 0.45 ml of solution in 15 to 30 sec at a depth
of 6 to 10 mm.
COMPLICATIONS:
• Necrosis of soft tissue due to highly concentrated
vasoconstrictor solution.

32. • For achieving profound anesthesia of hemi maxilla.
• 2 approaches 1) Greater palatine canal approach
2) High tuberosity approaches
• OTHER NAMES:-
Second division block, V2 nerve block
• AREAS ANESTHETIZED:-
1) Maxillary teeth on the affected side
2) Alveolar bone & overlying structures
3) Hard palate,part of soft palate
4) Upper lip, cheek, side of the nose, lower eye
lid
MAXILLARY NERVE BLOCK

33. • ADVANTAGES:-
1) Minimizes the no. of needle penetrations
2) Minimizes the total volume of local anesthetic
solution 1.8ml versus 2.7ml
3) high success rates

34. GREATER PALATINE APPROACH:-
TARGET AREA:- Maxillary nerve as it passes through
the pterygopalatine fossa, the needle passes through greater
palatine canal to reach pterygopalatine fossa
LAND MARKS:- Greater palatine foramen, situated
between the 2nd & 3rd molars about 1cm towards the midline
of the palate from the palatal gingival margin.
AREA OF INSERTION:- Palatal soft tissue directly over
the greater palatine foramen.
PROCEDURE:- 25 gauge 32 mm long needle used 1.8
ml of the solution in 1 minute is deposited at the target area

35. COMPLICATIONS:-
• Hematoma
• Penetration of the orbit during greater palatine foramen
approach if the needle goes too far
• Penetration of the nasal cavity occurs when the needle
deviates medially during insertion

36. SYMPTOMS-
• OBJECTIVE- instrumentation necessary to demonstrate
absence of pain sensation
• SUBJECTIVE- tingling & numbness of the upper lip, side
of the nose, & lower eyelid.

38. HIGH TUBEROSITY APPROACH
Technique:- needle used – 25 gauge 32mm long needle
LAND MARKS:-
• Muco buccal fold at the distal aspect of maxillary second molar.
• Maxillary tuberosity
• Zygomatic process of the maxilla
TARGET AREA:- Maxillary nerve as it passes through
pterygopalatine fossa superior & medial to the target area of
PSA nerve block.
DISADVANTAGES:-
• Risk of hematoma with high tuberosity approaches

40. INTRALIGAMENTARY ANESTHESIA
This is achieved by injecting an analgesic solution
directly into the periodontal membrane of the tooth.
USES:
• For extraction of teeth in hemophilic patients to avoid bleeding.
• Useful in pedodontic patients.
• Indicated prior to immediate replacement dentures.

41. TECHNIQUE: Finer needles of gauge 30 are inserted in
the periodontal membrane to a depth of 2mm.Needle is inserted
parallel with the long axis of the root of the tooth until it contacts
the alveloar bone. 0.2ml of solution is injected over a period of
30secs.Maxillary Molars require 3 injections and mandibular
molar 2 injections.
PERIOD OF ANESTHESIA: 30-45 mins
DISADVANTAGES:
Infection of the site.
Discomfort after the analgesia wears off.

42. SUPRA PERIOSTEAL
PSA
ASA
GREATER PALATINE
NASOPALATINE
PALATAL INFILTRATION
MAXILLARY NERVE BLOCK
0.6ML
0.9-1.8
0.9-1.2
0.45-0.6
0.45
0.2-0.3
1.8
Recommended volume of local anesthetic for
maxillary techniques

43. EXTRA ORAL TECHNIQUES

44. INFRA ORBITAL BLOCK
Indications:
Infection, Trauma resulting in impossible intra oral approach .
Anatomical Land marks:
• Pupil of the eye.
• Infra orbital ridge.
• Infra orbital notch.
• Infra orbital depression.

45. Technique:
• Using the available landmarks, the dentist should locate the
infra orbital foramen. The skin & subcutaneous tissue is
anesthesized by local infiltration
• 25 gauge needle used, and is directed slightly upward &
laterally which facilitates entrance into the foramen, which
open downward & medially.
SYMPTOMS
• SUBJECTIVE- tingling & numbness of the upper lip, side of
the nose & lower eyelid
• OBJECTIVE- instrumentation necessary to demonstrate
absence of pain.

46. MAXILLARY NERVE BLOCK
Indications:
• During extensive surgery
• To block all sub divisions of maxillary nerve with one needle
insertion
• Local infection and trauma causing difficulty for intraoral
approach
• For diagnostic and therapeutic purposes
Anatomical land marks:
• Mid point of the zygomatic arch
• Zygomatic notch
• Coronoid process of the ramus of mandible
• Lateral pterygoid plate

47. AREA ANAESTHETIZED-
• Maxillary teeth on the affected side
• Alveolar bone & the overlying structure
• Hard palate & portion of soft palate
• Upper lip, cheek, side of the nose & lower eyelid

48. Technique:
• The midpoint of the zygomatic process is
located & the depression in its inferior
surface is marked
• A skin wheal is raised just below this
mark, which the dentist identifies by
having the patient open & close the jaw
• The needle is inserted through the skin
wheal, until the needle point gently
contacts the lateral pterygoid plate.

49. • The needle is withdrawn , with only the
point left in the tissue, & re directed in a
slight forward & upward direction untill the
needle is inserted to the depth of the marker.
• After careful aspiration, 2-3ml of LA is
injected
• Care should be exercised to aspirate after
each 0.5ml of solution injected.

51. Click on the icon play
video

52. • TEXT BOOK OF LOCAL ANESTHESIA MALAMED
• INTERNET SOURCES