Clinically Relevant Anatomy

Question 1

What structure does the posterior superior alveolar nerve supply? (6)

Answer 1

• Second and third molars,
• Distobuccal and palatal cusps of the first molar
• Adjacent gingiva to teeth
• Mucosa
• Periodontium
• Buccal alveolar bone

Question 2

What structure does the middle superior alveolar nerve supply? (6)

Answer 2

• Mesiobuccal cusps of first molar
• Premolars
• Adjacent gingiva to teeth
• Mucosa
• Periodontium
• Alveolar bone

Question 3

What structure does the anterior superior alveolar nerve supply? (6)

Answer 3

• Canines
• Incisors
• Adjacent buccal gingiva to teeth
• Mucosa
• Periodontium
• Buccal alveolar bone

Question 4

What structure does the greater palatine nerve supply? (2)

Answer 4

• Palatal mucosa

- Bone adjacent to incisors and canines

Question 5

What structure does the lesser palatine nerve supply? (2)

Answer 5

• Soft palate

- Uvula

Question 6

What structure does the nasopalatine nerve supply? (2)

Answer 6

• Palatal mucosa

- Bone adjacent to molars, premolars and canines

Question 7

Where does the nasopalatine nerve exit the maxilla?

Answer 7

Incisive papilla

Question 8

Where do the greater and lesser palatine nerve exit the maxilla?

Answer 8

Greater and Lesser palatine foramen

Question 9

How much and where is LA used in palatal infiltrations?

Answer 9

0.2 ml distal to tooth

Question 10

Where should LA of the 3rd molar be carried out?

Answer 10

Anterior aspect of the tooth

Question 11

Which nerve supplies need LA in extractions?

Answer 11

Extractions requires anaesthesia of both buccal and palatal or nerve supply

Question 12

Which nerve supplies need LA in restorations?

Answer 12

Main nerve supply (buccal)

Question 13

What are the branches of the mandibular nerve which are important to LA (8)

Answer 13

• Mandibular nerves
• Auriculotemporal nerve
• Lingual nerves
• Inferior alveolar nerve
• Mylohyoid nerve
• Inferior alveolar nerve
• Mental nerve
• Incisive nerve

Question 14

What structure does the inferior alveolar nerve supply? (2)

Answer 14

• Mandibular teeth

- Alveolus

Question 15

What structure does the long buccal nerve supply? (2)

Answer 15

• Buccal gingiva

- Mucosa opposite

Question 16

What structure does the mental nerve supply?

Answer 16

Buccal gingiva and mucosa opposite premolars, canine and incisors, skin and
mucosa and the lower lip and chin

Question 17

What structure does the lingual nerve supply? (4)

Answer 17

• Anterior 2/3 of tongue
• Gingiva
• Mucosa
• Floor of mouth

Question 18

What is the inferior alveolar block used for?

Why is it used?

Answer 18

Teeth in the mandible where cortical plate is too thick for infiltration

Question 19

What are some advantages of infiltrations? (2)

Answer 19

• Simple techniques

- Anaesthetised all nerve endings in area

Question 20

What are some disadvantages of infiltrations? (3)

Answer 20

• LA must diffuses through bone
• Localised infection may be spread if an inflamed area is infiltrated
• Only a limited zone
  of anaesthesia per
  injection

Question 21

What are some advantages of nerve blocks? (3)

Answer 21

• Anaesthetic delivered to major nerve
• Blocks all sensation downstream of injection site
• More proximal the block, the greater

Question 22

What are some disadvantages of nerve blocks? (4)

Answer 22

• Regional blocks require complete knowledge of the anatomy (more challenging)
• Produce excessive soft tissue anaesthesia
• May cause haemorrhage in patients with bleeding disorders
• Potential for injury to a nerve trunk

Question 23

What is the space where you deposit LA for an inferior alveolar nerve block called?

Answer 23

Pterygomandibular space

Question 24

Describe what is;

Posterior
Lateral 
Medial & Inferior 
Superior
Anterior 

To the Pterygomandibular space

Answer 24

• Posterior: Parotid gland
• Laterally: Ramus
• Medially & inferiorly: Medial pterygoid muscle
• Superiorly: Lateral
  pterygoid muscle

Anteriorly: Buccinator muscle