This document discusses the anatomical considerations for dental local anesthesia. It describes the innervation of the maxillary and mandibular teeth, including the branches of the maxillary and mandibular nerves that supply specific teeth. It outlines the nerves that provide sensory and motor innervation, including the posterior superior alveolar nerve, zygomatic nerve, infraorbital nerve, and branches of the mandibular nerve such as the lingual nerve and inferior alveolar nerve. The document also discusses related structures like the sphenopalatine ganglion.

1. Hesham El-Hawary
Anatomical Consideration for dental local
Anesthesia
The innervation of maxillary and mandibular teeth

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Middle meningeal nerve

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Twigs to the sphenopalatine ganglion

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Posterior superior alveolar nerve

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Zygomatic nerve

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Infra-Orbital Nerve

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Middle superior alveolar nerve

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Anterior superior alveolar nerve

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Terminal branches of ION

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Branches of Maxillary nerve
1. Middle meningeal nerve
2. Twiges to the sphenopalatine ganglion
3. Posterior superior alveolar nerve
4. Zygomatic nerve
5. Infra-Orbital Nerve
1. Middle superior alveolar nerve
2. Anterior superior alveolar nerve
3. Terminal branches
1. Inferior palpebral nerve
2. Lateral nasal nerve
3. Superior labial nerve

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The Posterior Superior Alveolar
Neve

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• It arises from the
maxillary nerve just
before it enter the
infraorbital groove

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• Generally , posterior
superior alveolar
nerve is two in
number
• One branch descends
on the post. Surface
of the maxilla &
gives off several
twigs to m.m. of the
cheek

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• Other branch enters
small foramen on the
post. Surface of the
maxilla to run in the
post. Sup. Alveolar
canal located in the
posterior & lateral
walls of the max.
sinus

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 It communicate freely
with the middle &
anterior superior alveolar
nerves to form a
superior dental plexus
from which small twigs
enter the apical foramina
of the maxillary teeth &
other twigs supply the
overlying buccal
mucoperiosteum

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Posterior superior alveolar nerve
 Specifically posterior superior alveolar nerve supplies
– The Pulp
– The Investing structures
– The buccal mucoperiosteum
of Upper Molars except MB root of 1st molar(6)

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The Zygomatic Nerve

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• Arises from the maxillary
nerve as it enters the orbital
cavity
• Divides into two branches:
– Zygomatico-Tempopral
– Zygomatico-Facial
The Zygomatic Nerve

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Infra-Orbital Nerve

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The Infra-Orbital Nerve
• The maxillary nerve enters the inferior orbital fissure
to pass into the orbital cavity
• It turns slightly laterally in the infra-orbital groove and
continues forward in the orbital canal
• In the middle of the course in the canal it gives off the
middle superior alveolar nerve
• Just before the exit of the maxillary nerve from the
infra-orbital foramen and still in the infra-orbital canal
it gives off the anterior superior alveolar nerve
• As it leaves the infra-orbital foramen it gives off the
terminal branches

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Middle superior alveolar nerve
• Approximately in the middle of the infraorbital canal it
gives off the middle superior alveolar nerve
• It runs downward and forwards in a canal in the
lateral wall of the maxillary sinus to form part of the
superior dental plexus
• It Supplies
– Pulp
– Investing structures
– buccal mucoperiosteum
of Premolars & MB root of 1st molar(6)

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Anterior superior alveolar nerve
• Just before the exit of the maxillary nerve from the
infraorbital foramen, and while still in infraorbital canal
• It gives off the anterior superior alveolar nerve which
runs in a canal in the anterior wall of the maxillary sinus
to form part of the superior dental plexus
• It supplies
– Pulp
– Investing structures
– labial mucoperiosteum
of anterior teeth(1,2,3).

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Terminal branches of the maxillary nerve
• As the maxillary nerve leaves the infraorbital
foramen, it gives off its three terminal
branches, which are:
– Inferior palpebral nerve
– External nasal nerve
– Superior labial nerve

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The Sphenopalatine Ganglion

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• Nature: parasympathetic ganglion
• Site: pterygopalatine fossa hangs from the
maxillary nerve
• Roots:
– Sensory root: twigs from the maxillary nerve
to the sphenopalatine ganglion
– Sympathetic root: deep petrosal nerve
– Parasympathetic root: great superficial
petrosal nerve of the 7th cranial nerve
(Vidian nerve of facial nerve)

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• Branches:
– Orbital nerve
– Nasal nerve
– Palatine nerve
– Pharyngeal nerve

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• Branches:
– Orbital nerve
– Nasal nerve
– Palatine nerve
– Pharyngeal nerve

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• Branches:
– Orbital nerve
– Nasal nerve
– Palatine nerve
– Pharyngeal nerve

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• Branches:
– Orbital nerve
– Nasal nerve
– Palatine nerve
– Pharyngeal nerve

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• Branches:
– Orbital nerve
– Nasal nerve
– Palatine nerve
– Pharyngeal nerve

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Palatine Branches
• Palatine Branches Divides into:
–Greater (anterior) palatine nerve
–Lesser (posterior) palatine nerve

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Palatine Branches
• The greater (anterior) palatine nerve
– Emerges from greater (anterior) palatine foramen
in the horizontal part of the palatine bone medial
to the upper third molar
– Supplies palatal mucoperiosteum of maxillary
molars & premolars

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Palatine Branches
• The lesser ( posterior ) palatine nerve
– Emerges from Lesser (Posterior) palatine foramen
in the horizontal part of the palatine bone medial
to the upper third molar
– supplies uvula, soft palate & posterior part of
the hard palate

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Nasal Branches
• Nasal Branches Divides into:
– Long sphenopalatine nerve (nasopalatine nerve)
– Short sphenopalatine nerve

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Nasal Branches
• The Long sphenopalatine nerve
(nasopalatine nerve)
– Emerges from the incisive foramen in the anterior
part of the median plane of the palate
– supplies palatal mucoperiosteum of maxillary
anterior teeth

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Nasal Branches
• At the palatal side of the canine region, there is
anastomosis between the nasopalatine nerve &
greater palatine nerve
• The origin of these two nerves (nasopalatine
nerve& greater palatine nerve ) comes from the
sensory root of the sphenopalatine
gangalion (twigs from the maxillary nerve)

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Summary

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Pulp , Investing structures & Labial (buccal)
mucoperiosteum
Anterior superior alveolar nerve
Anterior teeth
(1,2,3)
Middle superior alveolar nerve
Premolars
(4,5) &
MB root of 1st
molar(6)
Posterior superior alveolar nerve
Molars except
MB root of 1st
molar(6)
Nerve supply of Maxillary teeth

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Palatal mucoperiosteum
Nasopalatine nerve
Anterior
teeth
(1,2,3)
Greater ( Anterior) palatine nerve
Premolars
(4,5)
&
Molars
(678)
Nerve supply of Maxillary teeth

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The accessory innervations of the teeth
• The buccal mucoperiosteum, the pulp and
investing structures of upper anterior teeth cross
innervation may take place i.e. branch from the anterior
superior nerve of the other side
• The palatal mucoperiosteum of the upper canine is
supplied by interlacing fibers between the greater
palatine nerve and the nasopalatine nerve

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Main Trunk

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Nervous Spimosum

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Nerve to medial pterygoid

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N. to Temporalis msc.

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N. to Massetter msc.

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N. to Lateral Pterygoid msc.

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Long Buccal N.

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Long Buccal N.

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Lingual Nerve

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Nerve to Mylohyoid muscle

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Inferior Alveolar Nerve

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Mental Nerve

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Incisive Nerve

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Branches of Mandibular Nerve
1. Main Trunk
2. Nervous Spimosum
3. Nerve to medial pterygoid
4. Anterior Division
– N. to Temporalis msc.
– N. to Massetter msc.
– N. to Lateral Pterygoid msc.
– Long Buccal N.
5. Posterior Division
– Auriculo-temporal N.
– Lingual Nerve
– Nerve to mylohyoid muscle
– Inferior Alveolar N.

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The Auriculo-Temporal nerve

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• It arises by a medial & a lateral root that unite
below the foramen spinosum
• The united nerve passes deep to the lateral
pterygoid muscle
• It gives off :
– Parotid branch
– Articular branch
– Auricular branch
– Temporal branch
– Terminal branch

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The Long Buccal Nerve

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Long Buccal Nerve
• Purely sensory nerve
• Passes between two heads of the lateral
pterygoid muscles
• It emerges beneath the anterior border of the
masseter muscle
• It crosses the anterior border of the ramus at
the level of the occlusal plane of the lower 7 & 8

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Long Buccal Nerve Cont.
It sends fibers to:
• M.M. of the cheek
Except the postero-superior area which receive sensory
fibers from posterior superior alveolar nerve
• Skin of the cheek
• M.M. of the lower buccal vestibule
• Buccal mucoperiosteum

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The Lingual Nerve

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• Purely sensory nerve
• Passes between the medial pterygoid muscle and
the ramus of the mandible in the
pterygomandibular space
• In the pterygomandibular space, it lies parallel to
the inferior alveolar nerve, but anterior and
medial (lingual) to it
• Then , it passes below the mandibular attachment
of the superior constrictor muscle of the
pharynx to reach the side of the base of the
tongue a short distance below & behind the lower
third molar (8)

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It supplies:
• M.M. of the ant. 2/3 of the tongue
• M.M. of the floor of the mouth
• M.M. of the lateral lingual vestibule
• Lingual mucoperiosteum of the all lower teeth
(1, 2, 3, 4, 5, 6, 7, & 8)

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The Inferior Alveolar Nerve

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• Mixed nerve (Sensory & Motor)
• Passes in the pterygomandibular space
• Before it enters the mandibular foramen, it gives
off the mylohyoid nerve, which contains
sensory & motor fibers
The Inferior Alveolar nerve

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The Inferior Alveolar Nerve
• Mylohyoid nerve
– Motor Fibers supply the
• Mylohyoid muscle
• Anterior belly of digastric muscles
– Sensory fibers supply the Pulp and investing
structures of the lower molars

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The Inferior Alveolar Nerve
• Within the mandible , the inferior alveolar nerve
descends in the inferior alveolar canal
• In the region of the mental foramen, it divides
into two terminal branches
– The mental nerve
– The Incisive nerve

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The Inferior Alveolar Nerve
Mental nerve
• leaves the mandible through the mental foramen
• It supply:
– Skin of the chin
– Skin of the lower lip
– M.M. of the lower lip
– Buccal mucoperiosteum of the mandibular anterior
teeth and premolars

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The Inferior Alveolar Nerve
Incisive nerve
• Supplies
– pulp & investing structures of the lower anterior
teeth (1, 2,& 3)
• Main trunk of the inferior

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Summary

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Nerve supply to the mandibular teeth
Pulp , Investing structures
Incisive nerve
Anterior teeth
(1,2,3)
Inferior alveolar nerve
Premolars
(4,5) &
Molars (678)

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Nerve supply to the mandibular teeth
Labial (buccal) mucoperiosteum
Mental nerve
Cutaneous coli nerve
( branch of cervical plexus C2 & c3 )
gives additional sensory supply for premolars ( 4 , 5 )
in about 20 % of the pt.
Anterior teeth
(1,2,3)
&
Premolars (45)
Long buccal nerveMolars (678)

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Nerve supply to the mandibular teeth
Lingual mucoperiosteum
Lingual nerve
Anterior teeth
(1,2,3) Premolars
(4,5) & Molars
(678)

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The accessory innervations of the teeth
• The pulp and investing structures of the lower
anterior teeth cross innervation may take place i.e.
branch from the incisive nerve of the other side
• The buccal mucoperiosteum of the lower premolar
may receive additional nerve supply from the cutaneous
coli nerve (branch from the cervical plexus of nerves)
• The pulp and investing structures of the lower
molars may receive additional nerve supply from the
nerve to mylohyoid

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