This ppt is all about the techniques of maxillary nerve blocks. The application of proper technique is extremely important for painless extraction.

1. Department of Oral & Maxillofacial Surgery
Presented by
Dr.Minakshi S. Agrawal

2. Maxillary nerve: the one of the three major branches or divisions of
the trigeminal nerve that supplies sensory fibers to
the skin areas of the middle part of the face, the
upper jaw and its teeth, and the mucous
membranes of the palate, nasal cavities, and
nasopharynx — called also maxillary division,
superior maxillary nerve;

4. Transmission in the nerve fibers of the 2nd division that innervate
the oral cavity may be interrupted by the following approaches:
 Intraoral techniques
1. Local infiltration of nerve endings
2. Block of terminal branches
3. Infraorbital nerve block
4. PSA nerve block
5. MSA nerve block
6. Nasopalatine nerve block
7. Greater palatine nerve block
8. Local infiltration of palate
9. Maxillary nerve block
10.Palatal approach anterior superior alveolar inj (P-ASA)

5. • Extraoraltechniques
1. Anterior middle superior alveolar nerve
block( AMSA)
2. Maxillary nerve block

6. Infraorbital nerve block

9. Nerves anesthetised
1. ASA
2. MSA
3. Inferior palpebral
4. Lateral nasal
5. Superior labial nerve
Indication
1. Dental procedure involving more than 2 maxillary teeth
2. Inflammation or infection which contraindicates
supraperiosteal inj.
3. When supraperiosteal inj. has failed

10. Contraindication
1. Discrete treatment areas (1 or 2 teeth only )
2. Hemostasis of localized area
Landmarks
a) Infraorbital ridge
b) Infraorbital depression
c) Supraorbital notch
d) Infraorbital notch
e) Anterior teeth
f) pupil of the eyes
Needle pathway during
insertion
A. Central approach
B. Bicuspid approach

13. PSA nerve block
• The posterior superior alveolar nerve block is a
commonly used dental nerve block.

14. Indication
 when treatment involves 2 or more maxillary molars
When supraperiosteal injection is contraindicated.
Contraindication
When risk of hemorrhage is too great.
Complication
1. Hematoma
2. Mandibular anesthesia

15. Landmarks
a. Mucobuccal fold & its concavity
b. Zygomatic process of the maxilla
c. Infratemporal surface of the maxilla
d. Anterior border & coronoid process of the ramus of
mandible
e. Tuberosity of the maxilla

17. Nasopalatine nerve block

18. Indication
To supplement the block of ASA & MSA nerves
For pain control during periodontal or oral surgical procedures.
Contraindication
• inflammation or infection at injection site.
Landmarks
•CI
•Incisive papilla

19. Complications
•Hematoma
•Necrosis of soft tissue

20. Greater palatine nerve block

21. Indication
 used in conjunction with the PSA or MSA nerve block
For surgery of the posterior portion of the hard palate
Landmark
 2nd & 3rd maxillary molar
 palatal gingival margin of 2nd & 3rd maxillary molars
Midline of palate
 a line approximately 1 cm from the palatal gingival
margin towards the midline of the palate

23. Maxillary nerve block
(intraoral technique)

24. Landmarks
2 types ( based on technique used)
A. High tuberosity technique
B. Greater palatine canal technique
Indication
1. When anestesia of the entire distribution of the maxillary
nerve is required for extensive surgery.
2. local infection
3. For diagnostic or therapeutic purposes such as trigeminal
neuralgia .

25. Needle position for high tuberosity technique

26. Needle position for greater palatine canal technique

28. Palatal approach anterior superior
alveolar nerve block

29. Anesthetic solution : 1.4 to 1.8 ml administered at a rate
of 0.5 ml per min
Landmark : incisive foramen

30. Extraoral Techniques
I. Anterior & middle superior alveolar nerve
block
•Indications
1. When the intraoral approach is not possible becoz of
infection trauma or other reason
2. When the intraoral methods have proved to be
ineffective.

31. •Landmarks
1. Pupil of eye
2. Infraorbital ridge
3. Infraorbital notch
4. Infraorbital depression

32. Maxillary nerve block
Indication
1. When anesthesia of the entire distribution of maxillary
nerve is required
2. When it is desirable to block all subdivisions with minimum
anesthetic solution.
3. When local infection, trauma , or other conditions blocks of
terminal branches difficult or impossible.
4. For diagnostic purpose , example in case of trigeminal
neuralgia.

33. Landmarks
1. Midpoint of the zygomatic arch
2. Zygomatic notch
3. Coronoid process of the ramus of mandible
4. Lateral pterygoid plate.

34. Thank You For Patient Hearing!
Department of Oral & Maxillofacial Surgery
Presented by
Dr.Minakshi Agrawal