MAXILLARY ANESTHESIA

Techniques of Maxillary Anesthesia

Local Infiltration Field Block Nerve Block

Maxillary Injection Techniques

Supraperiosteal Periodontal ligament Intraseptal injection Posterior superior alveolar nerve block Middle superior alveolar nerve block

Maxillary Injection Techniques

Anterior superior alveolar nerve block Maxillary (second division) nerve block Greater (anterior) palatine nerve block Nasopalatine nerve block

Supraperiosteal Injection

Indications
Pulpal anesthesia of one or two maxillary teeth Soft tissue anesthesia when indicated Hemostasis

Technique
Apply topical Landmarks - mucobuccal fold long axis of tooth Insert needle at height of mucobuccal fold Target area - apex of tooth Aspirate, deposit approx. 0.6-1 ml solution

Contraindications
Infection or acute inflammation in the area Dense bone covering apices of teeth

Areas Anesthetized
Entire area innervated by the large terminal nerve branches: Tooth pulp and root area Buccal periosteum Mucous membrane and connective tissue

Alternatives
Periodontal ligament injection Regional nerve block

Failures of Anesthesia
Inadequate needle penetration - not adjacent to tooth apex Needle too far from bone

Technique
Apply topical Landmarks - mucobuccal fold long axis of tooth Insert needle at height of mucobuccal fold Target area - apex of tooth Aspirate, deposit approx. 0.6-1 ml solution

Landmarks
Mucobuccal fold Maxillary tuberosity Zygomatic process of maxilla

Contraindication
Risk of hemorrhage is too great (eg. hemophelia, coumadin)

Disadvantages
Risk of hematoma Does not anesthetize first molar completely

No bony landmarks

Area of Insertion
Mucobuccal fold above maxillary second molar

Technique
25 gauge, long needle Position patient and identify landmarks

Advance needle upward, inward and backward Aspirate, inject 1.8 ml of solution

Failures of Anesthesia
Needle too lateral Needle not deep enough Needle too far superior

Complications
Hematoma Mandibular anesthesia

Techniques of Mandibular Anesthesia

Mandibular Anesthesia
Lower success rate than Maxillary anesthesia - approx. 80-85 % Related to bone density Less access to nerve trunks

Mandibular Anesthesia
Most commonly performed technique Has highest failure rate (15-20%) Success depends on depositing solution within 1 mm of nerve trunk

Inferior Alveolar Nerve Block

Not a complete mandibular nerve block. Requires supplemental buccal nerve block May require infiltration of incisors or mesial root of first molar

Inferior Alveolar Nerve Block

Inferior Alveolar Nerve Block

Areas Anesthetized Mandibular teeth to midline Body of mandible, inferior ramus Buccal mucosa anterior to mental foramen Anterior 2/3 tongue & floor of mouth Lingual soft tissue and periosteum

Inferior Alveolar Nerve Block

10%-15% positive aspiration

Inferior Alveolar Nerve Block

Technique Apply topical Area of insertion: medial ramus, mid-coronoid notch, level with occlusal plane (1 cm above), 3/4 posterior from coronoid notch to pterygomandibular raphe advance to bone (20-25 mm)

Inferior Alveolar Nerve Block

Precautions Do not inject if bone not contacted Avoid forceful bone contact

Odontogenic cyst

Trig N. -Small motor root.

- Large sensory root expand trig. G. - (sup orb. Fissue (ophlhalmic) - Max Rotundum - Mand Orale

Division
Ophthalmic
Max Mand

sup. Orbital Fissues orbit. complete sensory Complete sensory Rotundum Ovale Mixed motor/ sensory muscle of mastication.

Ophthalmic
3 branuclues before passing then sup. Abilities: - Fromtal. - Nasociliary - Lacrimal It receive communicating sympathatic branch confid symp. Plexus.

Lacrimal
Smallest Above lat rectus muscle Reach a lacrimal glaud Sensory lat eyelid skin over zygomatic of format bone -Post ganglonic for lacrimal gland. - Pre ganglionic fbers from sphenopalatine zygomatic branch of oph. N.

Ophthalmic
3 branches
- Frontal. - Nasociliary - Lacrimal It receive communicating sympathatic branch confid symp. Plexus.

Nasociliaray
Orbit
long root of ciliang of long ciliang N to Post elhmodal n

Nasal Cavity
Ant ethmoidal

Face
terminal b.

internal nasal
ext. nasal

ehmoidel
supply nose

bridge

Lingual N
- In front of inf alv. N - On the side of tongue - cross submand duct. - joined by chroned tympani. - sensory to awt 2/3 of tongue + floor of mouth. - pregancylionic passyw.

Inf. Alv. N
- 1st gives off N to myloyoid (Motor) 1) Ant belly of digastric. 2) Mylohyoid
Enter mandible thru mand formane Leave thru mental foramen.

Mand N
Ant Motor Except Buccel N. (sensory) Post Sensory except N to mylohoid (motor)

Analgesia surgical Anatomy

-Trig. N is the 5th CN - Largest. - Nerve Conveys: 1) Extereocaptive : pain touch thermal 2) Properio ceptive: deep pressure. 3) Strech impulse: muscle strech

Max N
Rotundum Enter ptegop fosse - Mid criminal F. - Ptrego p. t - Infra arbital groove/ canal - face

Branches of Max N.
Meningoal br. Zygomatic post supalve N Z. facial mid sup alv. N Aut sup alv. N

Z. temporal Passymp. To lacrimal g

Max N + Ptregop Gamglion

1) Mid Cranial Mid men, n. dura. 2) Ptegeo palatine F. a) Zygonmatic N inf. arbital F divide Zygometico facial Zygometico tmpural b) Post sup Alv. N. c) Ptregop. Fossa : Sensory to sphenop. G.

Max N. Sensory Rotundum Enter ptrgop fossa. Orbit thru inf. Arbital fissue. Emerge face thru infra orbital framen (side of nose + skin of face)

Nerves Entering Ganlion

Sensory root. pam syup + sympathatic.
Nervse earing gunglica Orbital Nasal - short sphenop - Long Sphenop

Palatanine - Grenter Awt Phaygeal

- Lesser post midlle

Mand N
Motor + Sensory root It has small Aut + Large post division

Mand N
Main trunk
menigeal
N to medical ptyoid

Awt division
Massetric
Deep temp.

Post division
auriclotemp

Lingual

lat ptyoid (open medial tensor vili buccal N (sensory) ptregoid (mucoms menals (close mand Retract) of cheeck)

inf. Alv. W

Buccal N

Sensory b. of Awt division of mand N. Supply all cheek muscles except post sup. Are. Which is supplied by post sup. Alv. N. buccal gingiva of molar teeth.

Facial N.
-Muscle of facial expression.

Lympnondes
Regional (collar)
Juglodigastric tonsil

deep
jugloomohyoid tongue carotid sheath

Regional
occipital parotid buccal Submental submandibular

300 LN Head Neck

Buccal N
Enter oral musosa of Level of occlusal plane of mand teeth + cross Ant border of Ramus

Lingual N
-Ant + Medical to inf alv. - Branch of post division. - Reach side of tongue. - Below lower 3rd molar. - loops under submental duct.

Manal N Post division

- Auriculo temparal

Contraindication
Risk of hemorrhage is too great (eg. hemophelia, coumadin)

Odontogenic cyst

Odontogenic cyst

Odontogenic cyst

Odontogenic cyst