Greater Palatine

Nerve Block
 Introduction
 The greater palatine nerve block is quite useful
during dental procedures involving the palatal
soft tissue distal to the canine.
 Minimum volumes of solution
(0.45 to 0.6 ml)provide profound hard and soft
tissue anesthesia.
 Greater palatine nerve course
 It is a branch of pterygopalatine ganglion.
 It descends through the greater palatine canal , emerges
upon the hard palate through greater palatine foramen
and courses in an anterior direction between the osseous
hard palate and mucoperiosteum to supply the major part
of the hard palate and palatine gingiva.
 Than it breaks up into many branches in its course and
extends as far as the premaxillary palatine mucosa.
 It supplies the gums,the mucous membrane and glands of
hard palate and communicate with the terminal filaments
of the nasopalatine nerve.
 Other Name : Anterior palatine nerve
block

 Nerve anesthetized : Greater palatine

 Area anesthetized

 Posterior portion of the

hard palate and its
overlying soft tissues ,
anteriorly as far as the
first premolar and
medially to the middle
line.
 Anatomical Landmarks

 Second and third maxillary molar

 Palatal gingival margin of second and third
maxillary molar.
 Midline of the palate
 A line approximately 1cm from the palatal
gingival margin toward the midline of the palate.
 Indications
 When palatal soft tissue anesthesia is required for
restorative therapy on more than two teeth.
 For pain control periodontal or oral surgical
procedure involving the palatal soft and hard
tissues.
 Contraindication

 Inflammation or infection at the injection site

 Smaller area of therapy(one or two teeth)
 Advantages

 Minimizes needle penetrations and volume of

solution
 Minimal patient discomfort
 Disadvantages

 No hemostasis except in the immediate area of

injection
 Potentially traumatic

Positive aspiration : Less than 1%

 Alternatives

 Local infiltration into specific regions

 Maxillary nerve block

 Technique

 A 27-gauge short needle recommended though

the 25-gauge short may also be used
 Area of insertion : soft tissue slightly anterior to
the greater palatine foramen
 Target area: greater palatine nerve as it passes
anteriorly between the soft tissues and bone of
the hard palate
 Landmarks: Greater palatine foramen and junction
of the maxillary alveolar process and palatine bone.

 Part of insertion: Advance the syringe from the

opposite side of the mouth at a right angle to the
target area.

 Orientation of the bevel: toward the palatal soft

tissue
Procedure
Assume the correct position
 For a right greater
palatine nerve block and
a right handed
administrator :

Sit facing the patient at

the 7 or 8’o clock
position.
 For left greater palatine
block and right handed
administration :

Sit facing in the same

direction as the patient at
11’o clock
Patient’s position
Request the patient ,who in a supine position to

 Open wide
 Extend the neck
 Turn the head to the left or right
Locate the greater palatine nerve

1) Place the cotton swab at the junction of the

maxillary alveolar process and the hard palate.
2) Start in the region of the maxillary 1st molar and
palpate posteriorly by pressing firmly into the
tissue with swab.
3) The swab will fall into the depression created by
the greater palatine foramen.
4)The foramen is most frequently located distal to
the maxillary second molar,but it may be either
anterior or posterior to its usual position.
 Prepare the soft tissue at the injection site, just 1
to 2 mm anterior to the greater palatine foramen.

 Clean and dry with sterile gauze

 Apply topical antiseptic
 Apply topical anesthetic
 After 2 min of application,move the swab posteriorly
so it is directly over the greater palatine foramen
1) Apply considerable pressure at the area of the
foramen with swab in the left hand(if right handed)
2) Note ischemia(whitening of the soft tissues)at the
junction site.
3) Apply pressure for a minimum of 30second and
while doing this proceed to
 Direct the syringe into the mouth from the
opposite side the needle approching the injection
site at a right angle.
 Place the bevel of the needle gently against the
previously blanched soft tissue at the junction site.
It must be stabilized to prevent accidental
penetration of the tissues.
 With bevel lying against the tissue
1) Apply enough pressure to bow the needle slightly.
2) Deposite a small volume of anesthetic . The
solution is forced against mucous membrane and
droplet forms.
 Straighten the needle and permit the bevel to
penetrate mucosa.
 (1) Continue to deposit small volumes of
anesthetic throughout the procedure.
 (2) Ischemia spreads into adjacent tissues as the
anesthetic is deposited
Continue to apply pressure anesthesia throughout the deposition of the anesthetic solution.Ischemia will spread as the vasoconstrictor decreases tissue perfusion
Slowly advance the needle until palatine bone is gently contracted.

(1) The depth of penetration will usually be less than 5 mm

(2) Continue to deposit small volumes of anesthetic. As the tissue is entered, there will be increased resistance to deposition of solution, which is entirely normal in the greater palatine nerve block.
 Aspirate in two planes.
 If negative, slowly deposit (30 sec minimum) not more than
one fourth to one third of a cartridge (0.45 to 0.6 ml).
• Slowly Withdraw the syringe.
• Make the needle safe.
Wait 2 to 3 mins before commencing the dental procedure.
Signs and symptoms

1. subjective: Numbness in the posterior portion of the palate

2.objective: No pain during dental therapy

Safety features
1. Contact with bone
2. Aspiration
Precautions

Do not enter the greater palatine canal. Although this is not hazardous, there is no reason to enter the canal for this technique to be successful
Failures of anesthesia
1. The greater palatine nerve block is not a technically difficult
injection to administer.
It incidence of success is well above 95%.
2. If local anasthetic is deposited too far anterior to the foramen,
adequate soft tissue anasthesia may not develop in the palatal
tissue posterior to the site of injection.
3. Anesthesia on the palate in the area of maxillary 1st premolar
may prove inadequate because of overlapping fibers from the
nasopalatine nerve
(A) to correct local infiltration may be neccesary as a supplement
in the area of inadequate anesthesia.
 COMPLICATIONS

 Few of significance
 Ischemia and necrosis of soft tissues when highly
concentrated vasoconstricting solution is used
over a long period of time for hemostatis.
 Hematoma is possible but is quite rare.
 Sometimes soft palate becomes anesthetized.
VIDEO
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