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Maxillary nerve block anesthetic technique (with photos)
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Maxillary nerve block anesthetic technique (with photos)

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Maxillary nerve block anesthetic technique (with photos) Maxillary nerve block anesthetic technique (with photos) Presentation Transcript

  • Hesham El-HawaryMaxillary Nerve Block TechniquesSurat An-Naml (The Ant
  • Hesham El-HawaryMaxillary Nerve Block TechniquesMaxillary AnestheticTechniquesDr. Hesham El-HawaryAssistant Professor OMFSwww.elhawarydentalclinic.com
  • Hesham El-HawaryMaxillary Nerve Block Techniques View slide
  • Hesham El-HawaryMaxillary Nerve Block Techniques1. Middle meningeal nerve2. Twiges to thesphenopalatine ganglion3. Posterior superior alveolarnerve4. Zygomatic nerve5. Infra-Orbital Nerve1. Middle superior alveolarnerve2. Anterior superior alveolarnerve3. Terminal branches1. Inferior palpebral nerve2. External nasal nerve3. Superior labial nerve View slide
  • Hesham El-HawaryMaxillary Nerve Block TechniquesPulp , Investing structures & Labial (buccal) mucoperiosteumAnterior superior alveolar nerveAnterior teeth(1,2,3)Middle superior alveolar nervePremolars (4,5) &MB root of 1stmolar(6)Posterior superior alveolar nerveMolars except MBroot of 1stmolar(6)Nerve supply of Maxillary teeth
  • Hesham El-HawaryMaxillary Nerve Block TechniquesPalatal mucoperiosteumNasopalatine nerveAnterior teeth(1,2,3)Greater ( Anterior) palatine nervePremolars (4,5)&Molars (678)Nerve supply of Maxillary teeth Cont.
  • Hesham El-HawaryMaxillary Nerve Block TechniquesKeep In Mind• Chair position (right handed – right side)• Dentist position (right handed – right side)• Nerve to be anesthetized• Armamentarium: Syringe (type) - Needle (size)• Landmarks (soft tissue – bony)• Technique– Point of insertion– Direction of insertion• Confirming the anesthesia (subjective – 0bjective)
  • Hesham El-HawaryMaxillary Nerve Block TechniquesNerve Block TechniqueMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block TechniquesLocal Anesthesia• Nerve Block– The anesthetic solution is deposited close to amain nerve trunk– Usually at a distance from the operative sitebefore the nerve divided into terminal branches
  • Hesham El-HawaryMaxillary Nerve Block TechniquesMaxillary NB anesthesiaIncisive N.B.Anterior & MiddleSup. Alv. N.B.Post. Sup. Alv. N.B.Palatine N.B.Maxillary N.B.
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block TechniquesPOSTERIOR SUPERIOR ALVEOLARNERVE BLOCK(ZYGOMATIC/TUBEROSITY NERVE BLOCK)Maxillary anesthetic Techniques
  • Hesham El-HawaryMaxillary Nerve Block TechniquesNerves to be anesthetized• Posterior Superior Alveolar Nerve– before it enters the posterior surface of themaxilla while it is in the infra-temporal fossa• It will anesthetize the: Pulp & investingstructures and buccal mucoperiosteum of themaxillary molars except for the mesio-buccalroot of the 1st molar
  • Hesham El-HawaryMaxillary Nerve Block TechniquesPositionsPatient position• Head , neck and trunk onthe same straight line• The back of the chair istilted so that it make a 45degree angle with the floor• So that when the patientopen his mouth the occlusalplane of the maxillary teethmakes 45 degree with thefloorDentist position In the left p.s.a. sits in a 10o’clock position In the right p.s.a. he sits inan 8 o’clock position
  • Hesham El-HawaryMaxillary Nerve Block TechniquesArmamentarium• Needle:– 25-27 gauge– Long needle• Syringe– Aspirating syringe
  • Hesham El-HawaryMaxillary Nerve Block TechniquesLandmarks• Landmarks– Muccobuccal fold– Maxillary tuberosity– Zygomatic process
  • Hesham El-HawaryMaxillary Nerve Block TechniquesTechnique1. Retract the cheek and prepare site of injection2. The needle is introduced into the height of themucobuccal fold above the 2nd molar3. Advance the needle slowly upward, backward and inward4. The needle shouldn’t touch bone, and the max. depthallowed is ½ the length of the long needle, then ASPIRATE5. If blood comes out then retract and try again, but if youget blood also the next time then abort the technique6. If no blood comes out then deposit 1.5 ml of theanesthetic solution, wait 3-5 minutes before working
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block TechniquesConfirming the Anesthesia• Subjective findings– No subjective findings• Objective findings– Probing does not lead to pain
  • Hesham El-HawaryMaxillary Nerve Block TechniquesMAXILLARY NERVE BLOCKMaxillary anesthetic Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques• The purpose of this technique is to block the maintrunk of the maxillary nerve as it traverses thepterygopalatine fossa after emerging fromforamen rotandum
  • Hesham El-HawaryMaxillary Nerve Block TechniquesMaxillary Nerve Block To accomplish this the same landmarks as thepost. Sup. Alv. N. block is used but you have toenter the needle about 2/3 of its length A larger amount is used in this case where4ml are deposited slowly and after aspirationto achieve a successful result It is very rare to be done
  • Hesham El-HawaryMaxillary Nerve Block TechniquesConfirming the Anesthesia• Subjective findings– Numbness of:• The palate• Upper lip• Lateral aspect of the nose• Lower eye lid• Objective findings– Probing does not lead to pain in the palate andbuccal mucosa in any aspect
  • Hesham El-HawaryMaxillary Nerve Block TechniquesINFRAORBITAL NERVE BLOCK(ANTERIOR AND MIDDLE SUPERIOR ALVEOLAR NERVE BLOCK)Maxillary anesthetic Techniques
  • Hesham El-HawaryMaxillary Nerve Block TechniquesInfra Orbital N. BLOCK The aim is to deposit the anesthetic solution into theinfraorbital canal through the infraorbital foramen In this technique the anterior & middle superioralveolar nerves are anesthetized in 80% of cases• In the remaining 20% the middle sup.alv.nerve has to be given a separate injection
  • Hesham El-HawaryMaxillary Nerve Block TechniquesNerves to be anesthetized• The terminals of the infraorbital nerve• The anterior superior alveolar nerves• The middle superior alveolar nerve
  • Hesham El-HawaryMaxillary Nerve Block TechniquesAreas to be anesthetized The upper lip The lateral aspect of the nose The lower eyelid The buccal mucosa of the upper anterior teeth and premolars Pulp and investing structures of upper anterior teeth andpremolars
  • Hesham El-HawaryMaxillary Nerve Block TechniquesPositionsPatient position• Head , neck and trunk on thesame straight line• The back of the chair is tilted sothat the patient is in a supineposition• The occlusal plan of maxillaryteeth– Near to the operator’sshoulder– At a 45 degrees angle to thefloorDentist position• Stands on the right sideinfront of the patientfor a right side injection• Along side the patientfor a left side injection
  • Hesham El-HawaryMaxillary Nerve Block Techniques• Needle:– 25-27 gauge– Long needle• Syringe– Aspirating syringeArmamentarium
  • Hesham El-HawaryMaxillary Nerve Block TechniquesNeedle insertionThe point of needle insertionThe infraorbital foramenDirection of insertion• Will be discussed in thetechnique
  • Hesham El-HawaryMaxillary Nerve Block Techniques1. Clean the tissue to be injected with sterile gauze2. Apply topical antiseptic followed by topicalanesthetic3. Pull the upper lip taut4. Locate the infraorbital foramen which is– About 5mm below the infraorbital ridge between themiddle and inner thirds– The foramen also lies in one vertical line with the pupilwhen the patient gazes forwardsTechnique
  • Hesham El-HawaryMaxillary Nerve Block Techniques5. There are 3 acceptable methods of approaching theinfraorbital foramen: First technique– A vertical imaginary line is drawn from the inner canthus ofthe eye until it intersects with another imaginary linedrawn in the mucobuccal fold forming a right angle– A 25 gauge needle is inserted in the mucobuccal fold about5 mm lateral to the maxillary alveolar bone directing it tobisect this imaginary right angleTechnique
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques5. There are 3 acceptable methods of approaching theinfraorbital foramen: Second technique– The crown of the central incisor on the side of the tooth tobe operated on is bisected by the needle from themesioincisal edge to the distogingival angle with the pointof insertion 5 mm out from the mucobuccal fold to thelevel of the canine apexTechnique
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques5. There are 3 acceptable methods of approaching theinfraorbital foramen: Third technique– The syringe and needle are lined up with a vertical linewith the longitudinal axis of maxillary 2nd premolar in linewith the pupil of the eye while patient gazes forwards– The needle is inserted 5mm out in the mucobuccal foldTechnique
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques6. The needle is oriented with bevel towards bone andadvanced slowly till it contacts the upper rim of theinfraorbital foramenThe depth of penetration should not exceed 20 mm6. Aspirate, if negative deposit the anesthetic solutionslowly7. Wait 3-5 minutes before commencing dentalprocedureTechnique
  • Hesham El-HawaryMaxillary Nerve Block TechniquesConfirming the Anesthesia• Subjective findings– Numbness of• The lower eye lid• Lateral wall of the nose• Upper lip• Objective findings– Probing does not lead to pain in the mucosaopposite to the anterior teeth and premolars
  • Hesham El-HawaryMaxillary Nerve Block TechniquesINCISIVE CANAL NERVE BLOCK(NASOPALATINE NERVE BLOCK)Maxillary anesthetic Techniques
  • Hesham El-HawaryMaxillary Nerve Block TechniquesNerves to be anesthetized This is a painful injection so it is better to give a few drops ofanesthesia superficially before proceeding with the rest of theinjection The aim is to anesthetize the nasopalatine nerve inside the incisivecanal Area to be anesthetized:The mucosa of the Anterior part of the palate opposite to the anterior teeth
  • Hesham El-HawaryMaxillary Nerve Block TechniquesPositionsPatient position• Head , neck and trunk on thesame straight line• The back of the chair is tilted sothat the patient is in a supineposition• The occlusal plan of maxillaryteeth near to the operator’sshoulderDentist position• The operator will sitfrom infront and to theright
  • Hesham El-HawaryMaxillary Nerve Block Techniques• Needle:– 25-27 gauge– Short needle• Syringe– Non-Aspirating syringeArmamentarium
  • Hesham El-HawaryMaxillary Nerve Block TechniquesIncisive canal N.Block Technique Cont.The point of needle insertionThe incisive foramen i.e. thecrest of the incisive papillaDirection of needle insertion• into the crest of the incisivepapilla between the uppercentrals making 45◦degrees to the palatalmucosa
  • Hesham El-HawaryMaxillary Nerve Block Techniques1. Ask patient to open wide2. A labioginigval crest injection is made to anesthetizethe incisive papilla first3. The needle is oriented parallel with the labialalveolar plate with the needle directed towards thecrest of the incisive papilla i.e. The needle approachis from between the upper centrals making an angleof 45 degrees to the palatal mucosa4. The needle is inserted into the crest of the incisivepapilla for a distance of 4 mm5. Inject 0.3 ml of anesthetic solutionTechnique
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block Techniques
  • Hesham El-HawaryMaxillary Nerve Block TechniquesConfirming the Anesthesia• Subjective findings– Numbness of the anterior 1/3 of the palate• Objective findings– Probing does not lead to pain in the anterior 1/3of palate
  • Hesham El-HawaryMaxillary Nerve Block TechniquesGREATER PALATINE NERVE BLOCKMaxillary anesthetic Techniques
  • Hesham El-HawaryMaxillary Nerve Block TechniquesNerves to be anesthetized The aim of this technique is to block the greaterpalatine nerve as it comes out of its foramen It’s foramen usually lies distal to the upper 2nd molar,but it can be more anterior Areas to be anesthetized:Palatal mucosa of the molars and premolars
  • Hesham El-HawaryMaxillary Nerve Block TechniquesPositionsPatient position• Head , neck and trunk on thesame straight line• The back of the chair is tilted sothat the patient is in a supineposition• The occlusal plan of maxillaryteeth near to the operator’sshoulderDentist position• The operator will sitfrom infront and to theright
  • Hesham El-HawaryMaxillary Nerve Block Techniques• Needle:– 25-27 gauge– Short needle• Syringe– Non-Aspirating syringeArmamentarium
  • Hesham El-HawaryMaxillary Nerve Block TechniquesNeedle InsertionThe point of needle insertionThe greater palatine foramendistal to the palatal aspectof the second molarDirection of needle insertion• from the opposite side atright angle
  • Hesham El-HawaryMaxillary Nerve Block Techniques1. Ask patient to open wide2. Palpate the position of the greater palatine foramentill you feel its depression3. Clean the tissue to be injected with sterile gauze4. Apply topical antiseptic followed by topicalanestheticTechnique
  • Hesham El-HawaryMaxillary Nerve Block Techniques5. A 27 gauge needle is inserted from the oppositeside to which the injection is to be made with theneedle approaching the site of injection at rightangle. The needle is advanced through soft tissueuntil bone is contacted6. About 0.5 ml of the anesthetic solution is deposited7. Withdraw syringe and recap needle8. Wait 2-3minutes before commencing dentalprocedureTechnique
  • Hesham El-HawaryMaxillary Nerve Block TechniquesConfirming the Anesthesia• Subjective findings– Numbness of the posterior 2/3 of the palate• Objective findings– Probing does not lead to pain
  • Hesham El-HawaryMaxillary Nerve Block TechniquesTHANK YOUMaxillary Anesthetic Techniques