maxillary nerve blocks

DEPARTMENT OF ORAL AND
MAXILLOFACIAL SURGERY
Presented by –
ABHIJEET KAMBLE
FINAL YEAR
Maxillary nerve blocks
• Seminar on -

www.themegallery.com
Techniques of Maxillary Anesthesia

Types of Injections
I. Supraperiosteal (infiltration)
II. Periodontal ligament (PDL, intraligamentary)
III. Intraseptal injection
IV. Posterior superior alveolar nerve block
V. Middle superior alveolar nerve block
VI. Anterior superior alveolar nerve block
VII. Greater (anterior) palatine nerve block
VIII. Nasopalatine nerve block
IX. Maxillary (second division) nerve block
X. Anterior meddle superior alveolar nerve block
XI. Palatal approach-anterior superior alveolar n block

Supraperiosteal Injection

Nerves anesthetized– terminal branch of dental plexus
Areas anesthetized
 Entire region innervated by the large terminal branches of this
plexus
Indications
1. Pulpal anesthesia of maxillary teeth when treatment is limited
to 1 or 2 teeth
2. Soft tissue anesthesia when indicated for surgical procedure
Contraindications
1. Infection or acute inflammation
2. Dense bone covering the apices of teeth

Advantages
1. High success rate (>95%)
2. Easy & usually entirely atraumatic
Disadvantages
 Not recommended for larger areas because of multiple
injection
Alternatives– PDL, IO, regional block
Anatomical landmark:
 Mucobuccal fold
 Crown of the tooth
 Root contour of the tooth

Technique
1. Lift the lip, pulling the tissue taut
2. Hold the syringe parallel to the long axis of the tooth
3. Insert the needle at the height of the mucobuccal fold over the
target tooth
4. Advance the needle until its bevel is at or above the apical
region of the tooth
5. Aspirate, if –ve , deposit 0.6 ml slowly over 20 seconds
Sighs & symptoms
1. Subjective: feeling of numbness in the area of administration
2. Objective: no pain during therapy

Safety features
1. Minimal risk of intravascular administration
2. Slowness of injection, aspiration
Precautions
 should not be used for larger areas
Complications
 pain on needle insertion with the tip against periosteum

Posterior superior alveolar nerve blockPosterior superior alveolar nerve block

Nerves Anesthetized-
 Posterior superior alveolar
and its branches
Areas Anesthetized-
1) Pulps of the maxillary 3rd
, 2nd
and 1st
molars
2) Buccal periodontium and
bone overlying these teeth
Anatomical Landmarks-
1. Mucobuccal fold and its
concavity
2. Zygomatic process of the
maxilla
3. Infratemporal surface of the
maxilla
4. Anterior border and coronoid
process of the ramus of the
mandible
5. Maxillary tuberosity

Anterior superior alveolar(ASA) nerve block

 3. Buccal(labial)
periodontium and
bone of these teeth
 4. Lower eyelid,
lateral aspect of the
nose, upper lip
Anatomical
landmarks
1. Infraorbotal notch
2. Infraorbital
depression
3. Infraorbital ridge
4. Supraorbital notch
5. Anterior teeth
6. Pupils of eye

Middle Superior Alveolar Nerve Block

Nerves anaesthetized
MSA & terminal branch
Areas anaesthetized
1. Pulps of maxillary 1st
& 2nd
premolar & mesiobuccal root of
1st
molar(28%)
2. Buccal periodontal tissues &
bone of these teeth
Anatomical landmarks
 Mucobuccal fold above the
maxillary 2nd
premolar
Advantages– minimizes no. of
injection & volume of solution

Greater palatine nerve block

Nasopalatine Nerve Block

Technique
Two types of technique– 1.single
penetration
2. multiple penetration
Technique-1 (single)
1. Area of insertion– palatal mucosa just lateral
to the incisive papilla
2. Target area– incisive foramen beneath the
papilla
3. Path– approach the injection site at 45 degree
angle toward the papilla
4. Chair position– 9 or 10 o’clock position facing
in the same direction as the patient
5. Slowly advance the needle towards the
foramen until bone is gently contacted (depth
approx. 5 mm)
6. Slowly deposit 0.45 ml in 15-30 second
minimum

3. Procedure
4.
a) 1st
injection: retract the upper lip to stretch
tissues & improve visibility. Gently insert in
the frenum & deposit 0.3 ml in approx. 15
seconds
b) 2nd
injection: at 11 or 12 o’clock position,
tilting the patients head in the right, &
needle at right angle to interdental papilla
needle is inserted into the papilla just
above the level of crestal bone. Aspirate
when ischemia is noted in the incisive
papilla or needle tip become visible just
beneath the tissue surface
 Signs & symptoms
1. Subjective: numbness in the upper lip & anterior
portion of the hard palate
2. Objective: no pain therapy
 Safety features
1. Aspiration
2. Contact with bone

Maxillary nerve block

Alternatives
1. PSA nerve block
2. ASA nerve block
3. GP nerve block
4. Nasopalatine nerve block
Technique– 2-type: high tuberosity
approach & GP canal approach
 High-tuberosity approach
1. Area of insertion– height of
mucobuccal fold above the distal
aspect of 2nd
molar
2. Target area– maxillary n. as it passes
through the pterygopalatine fossa
• superior and medial to the target area
of PSA n. block

Anterior middle superior alveolar nerve block

 Advantages
1. Provides anesthesia of multiple teeth
with single injection
2. Minimizes volume of anesthesia & no. of
puncture
3. Allows effective soft tissue & pulpal
anesthesia for periodontal scaling 7 root
planing
4. Allows accurate smile line assessment
5. Eliminates postoperative inconvenience
of numbness to the upper lip & muscle of
facial expression
6. Can be perform comfortably with a
CCLAD
 Disadvantages
1. Requires a slow administration time ( 0.5
ml/min)
2. Can cause operator fatigue with a
manual syringe
3. May need supplemental anesthesia for
C.I. & L.I.

maxillary nerve blocks

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