Technique of maxillary anesthesia
- 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)
Editor's Notes
- #12: There are basically two techniques of NP Block. 1. Single injection 2. Three injection Technique. Single injection technique will be discussed.