Maxillary Anesthesia part 4

1. PALATAL ANESTHESIAPALATAL ANESTHESIA

2. Greater Palatine Nerve BlockGreater Palatine Nerve Block
Anterior Palatine NerveAnterior Palatine Nerve
Posterior portion of hard palate andPosterior portion of hard palate and
overlying soft tissuesoverlying soft tissues
Anteriorly to 1st premolarAnteriorly to 1st premolar
Medially to midlineMedially to midline

5. Greater Palatine Nerve BlockGreater Palatine Nerve Block
IndicationsIndications
Pain control in posterior palatal hard and/orPain control in posterior palatal hard and/or
soft tissuessoft tissues
ContraindicationsContraindications
Inflammation / infection at injection siteInflammation / infection at injection site
Only small area necessary (eg. 1-2 teeth)Only small area necessary (eg. 1-2 teeth)

6. Greater Palatine Nerve BlockGreater Palatine Nerve Block
AdvantagesAdvantages
Minimizes penetrations and discomfortMinimizes penetrations and discomfort
Minimizes volume of solution (0.5 ml)Minimizes volume of solution (0.5 ml)
DisadvantagesDisadvantages
Limited hemostasisLimited hemostasis
Potentially traumaticPotentially traumatic

7. Greater Palatine Nerve BlockGreater Palatine Nerve Block
AlternativesAlternatives
Local infiltration in each areaLocal infiltration in each area
Maxillary Nerve BlockMaxillary Nerve Block
AspirationAspiration
< 1% positive< 1% positive

8. Greater Palatine Nerve BlockGreater Palatine Nerve Block
LandmarksLandmarks
Greater palatine foramenGreater palatine foramen
Junction of alveolus and palatine boneJunction of alveolus and palatine bone
Area of InsertionArea of Insertion
Soft tissue anterior to foramen, fromSoft tissue anterior to foramen, from
opposite sideopposite side

9. Greater Palatine Nerve BlockGreater Palatine Nerve Block
PrecautionsPrecautions
Do notDo not enter canalenter canal
Signs & symptomsSigns & symptoms
Numb posterior palate; painfree treatmentNumb posterior palate; painfree treatment
Safety featuresSafety features
Bone contacted; aspirationBone contacted; aspiration

11. Greater Palatine Nerve BlockGreater Palatine Nerve Block
TechniqueTechnique
Position - open wide, extend & turn headPosition - open wide, extend & turn head
Cotton swab - identify landmarks, topicalCotton swab - identify landmarks, topical
Approach - bevel to tissue, advance to boneApproach - bevel to tissue, advance to bone
Aspirate; inject 0.5 ml slowlyAspirate; inject 0.5 ml slowly

14. Greater Palatine Nerve BlockGreater Palatine Nerve Block
FailureFailure
Overlap of fibers from Nasopalatine nerveOverlap of fibers from Nasopalatine nerve
Injection too anteriorInjection too anterior
ComplicationsComplications
Soft tissue ischemia / necrosisSoft tissue ischemia / necrosis
Post injection pain, hematomaPost injection pain, hematoma

15. NASOPALATINE NERVE BLOCKNASOPALATINE NERVE BLOCK

17. Nasopalatine Nerve BlockNasopalatine Nerve Block
IndicationsIndications
Pain control in anterior hard and/or softPain control in anterior hard and/or soft
tissuestissues
ContraindicationsContraindications
Inflammation / infection at injection siteInflammation / infection at injection site
Only small area necessary (eg. 1-2 teeth)Only small area necessary (eg. 1-2 teeth)

18. Nasopalatine Nerve BlockNasopalatine Nerve Block
AdvantagesAdvantages
Minimizes needle penetrationsMinimizes needle penetrations
Minimizes volume of solution (0.4 ml)Minimizes volume of solution (0.4 ml)
DisadvantagesDisadvantages
Limited hemostasisLimited hemostasis
Potentially traumaticPotentially traumatic

19. Nasopalatine Nerve BlockNasopalatine Nerve Block
AlternativesAlternatives
Local infiltrationLocal infiltration
Maxillary Nerve BlockMaxillary Nerve Block
AspirationAspiration
< 1% positive< 1% positive

20. Nasopalatine Nerve BlockNasopalatine Nerve Block
PrecautionsPrecautions
Do not inject directly into papilla/canalDo not inject directly into papilla/canal
Inject slowly, with small volumeInject slowly, with small volume
Signs / symptomsSigns / symptoms
Numb anterior palate; painfree treatmentNumb anterior palate; painfree treatment
Safety featuresSafety features
Bone contacted; aspirationBone contacted; aspiration

21. Nasopalatine Nerve BlockNasopalatine Nerve Block
TechniqueTechnique
Position - open wide, extend headPosition - open wide, extend head
Landmarks - incisive papilla, centralLandmarks - incisive papilla, central
incisorsincisors
Approach - lateral to incisive papilla,Approach - lateral to incisive papilla,
starting with cotton swab, topicalstarting with cotton swab, topical
Deposit approx. 0.4 ml / 30 secDeposit approx. 0.4 ml / 30 sec

24. Nasopalatine Nerve BlockNasopalatine Nerve Block
FailureFailure
May be only unilateralMay be only unilateral
May have overlap with Greater PalatineMay have overlap with Greater Palatine
ComplicationsComplications
Ischemia, tissue necrosisIschemia, tissue necrosis
Others rareOthers rare