MAXILLARY NERVE

BLOCK
By : Maitreyi Limaye (3rd BDS)
 MAXILLARY NERVE
 It is purely SENSORY in function.
 2nd division of trigeminal nerve arise from the
middle of trigeminal ganglion.
 Originating from trigeminal ganglion ,it travels
along the LATERAL WALL of the CAVERNOUS
SINUS.
 Before exiting middle cranial fossa, it gives off
a MENINGEAL BRANCH – innervates the DURA
MATER.
 Then it enters Pterygopalatine Fossa via the
FORAMEN ROTUNDUM
 Within fossa , it gives rise to 4 branches:
 1. posterior superior alveolar nerve.
 2. zygomartic nerve
 3. pterygopalatine nerves
 4. infraorbital nerve.
 NERVE SUPPLY OF MAXILLARY
TEETH
 Pulp ,investing structures and labial(buccal)
mucoperiosteum:
 Anterior teeth(1,2,3), premolar(4,5) and MB of
1st molar (6) : anterior surerior alveolar nerve.
(infraorbital nerve)
 Premolars(4,5) and MB root of 1st molar(6):
middle superior alveolar nerve.
 Molars except MB root of 1st molar(6): posterior
superior alveolar nerve.
 Anterior teeth (1,2,3): nasopalatine nerve.
 Premolars and molars : greater palatine nerve.
LOCAL ANESTHESIA
 Local infiltration: flooding of the small
terminal nerve endings with local anesthetic
solution.
 Field block: local anesthetic solution is
deposited in the vicinity of larger terminal
nerve fiber.
 Nerve block: the anesthetic solution is
deposited close to a main nerve trunk,
MAXILLARY NERVE BLOCKS
 Blocks covered:
 Posterior superior alveolar nerve block
 Middle superior alveolar nerve block
 Anterior superior alveolar nerve
block(infraorbital nerve block)
 Greater palatine nerve block
 Nasopalatine nerve block
 Anterior middle superior alveolar nerve block
 Maxillary nerve block.
POSTERIOR SUPERIOR
ALVEOLAR NERVE BLOCK(PSA)
 PSA nerve block is
commonly used
dental nerve block.
 It is highly
successful
technique (>95%).
 Other common
names are :
 Tuberosity block,
 Zygomatic block.
POSTERIOR SUPERIOR
ALVEOLAR NERVE BLOCK.
 Landmarks :
1) Mucobuccal fold and its concavity.
2) Zygomatic process of the maxilla
3) Infratemporal surface of maxilla
4) Anterior border and coronoid process of ramus of
mandible
5) Tuberosity of the maxilla.
 Nerves anaesthetised : posterior superior
alveolar and branches.
 Areas anaesthetised: pulps of the maxillary
3rd ,2nd and 1st molars (except the MB cusp of
maxillary 1st molar in 28% of PSA nerve block)
PSA NERVE BLOCK
 Technique :
 25 guage short needle recommended.
 Area of insertion: height of the mucobuccal
fold above the maxillary 2nd molar .
 Target area: posterior ,superior, and medial
to the posterior border of maxilla.
 Orientation of the bevel of needle towards
bone during the injection. If bone is
accidentally touched, the sensation is less
unpleasant .
 orient the bevel of the needle toward bone.
 Partially open the patient’s mouth ,pulling
the mandible to the side of injection.
 Retract the patient cheek with your finger.
 Advance the needle slowly in asn upward,
inward and backward direction in one
movement,
 Upward : at a 45- degree angle to occlusal
plane.
inward : medially toward the midline at a 45-
degree angle to occlusal plane
backward: posteriorly at 45-degree angle to
long axis of the second molar.
 Indications: when  Disadvantage :
treatment involves two  Risk of hematoma
or more maxillary  Technique somewhat
molars. arbitary( no bony
landmark during
 Contraindications : insertion)
when the risk of  2nd injection necessary
hemorrhage is too great for treatment of the 1st
( in hemophilia) molar.

 Advantages :  Complications:
atraumatic , high hematoma , mandibular
success rate , minimum anesthesia: mandibular
number of necessary division of the 5th
injection, minimize the cranial nerve is located
total volume of LA lateral to PSA nerve.
solution administered.
MIDDLE SUPERIOR ALVEOLAR
NERVE BLOCK(MSA)
 Middle superior
alveolar nerve block.
 Landmark:
mucobuccal fold
where it intersects
with the junction of
maxillary premolar 2
and molar 1.
 Nerve anesthetized:
MSA and its terminal
branches.
MSA NERVE BLOCK
 Areas anesthetized: pulps of maxillary 1st and
2nd premolars and MB root of the 1st molar.
and buccal periodontal tissue and bone over
these same teeth.
 Technique:
 25 guage short or long needle is recommended.
 Area of insertion: height of mucobuccal fold
above the maxillary 2nd premolar.
 Target area: maxillary bone above the apex of
maxillary 2nd premolar.
 Landmark:mucobuccal fold above the maxillary
2nd premolar.
CONTD….TECHNIQUE.
 Orientation of bevel: toward bone
 Stretch the patient’s upper lip.
 Insert the needle into height of mucobuccal
fold above the 2nd premolar with the bevel
directed toward bone.
 Slowly advance the needle and then deposit
(0.9 to 1.2 ml) for 30 to 40 sec.

 Indication: dental procedures involving tooth

maxillary premolar only.
 Contraindication: infection or inflammation in
the area of injection and when MSA is absent.
 Advantage : minimize the number of
injections and volume of solution.
 Disadvantages : none.

 Sigs and symptoms : upper lip numbness, and

no pain during dental treatment.

 Complications : hematoma at the site of

injection.
INFRA ORBITAL NERVE BLOCK(ANTERIOR
SUPERIOR ALVEOLAR NERVE)
Nerves anesthetized:
anterior superior
alveolar nerve,middle
superior alveolar
nerve,infraorbital nerve,
inferior palpebral,
lateral nasal and
superior labial nerves.
 Areas anesthetized: pulp
of maxillary central
incisor through the
canine on the injected
side and maxillary
premolars and MB cusp
of 1st molar.
INFRA ORBITAL NERVE BLOCK.
 Contd..areas anesthetized
 Buccal\ labial periodontium and bone of these
same teeth.
 Lowe eyelid, lateral aspect of the nose, upper lip
.
 Landmarks: infraorbital ridge, infraorbital
depression, infraorbital notch,supraorbital
notch, anterior teeth and pupils of the eye.
 Technique: a 25 guage long needle is
recommended .
 Area of insertion : height of mucobuccal fold
directly over the first premolar.
 Target area : infra orbital foramen.
TECHNIQUE
 Insert the needle into mucolabial fold from
either one of two direction.
 The needle should be held parallel with the
long axis of the tooth as it is advanced.
 The bevel of needle facing into the infraorbital
foramenand the needle tip touching the roof of
the foramen.
 Then aspirate and deposite 0.9 to 1.2 ml over
30 to 40 sec.

 Signs and symptoms: tingling and numbness of

upper lip , lower eyelid and side of nose.
 Absence of pain sensation.
 Contraindication: hemostasis of localized
areas

 Advantages: simple technique , safe .

 Disadvantages: psychologically : there may

be an initial fear of injury to the patient’s
eye.
difficulty in defining landmarks.
 Complications:hematoma