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Pain and Anxiety > LA in the Maxilla > Flashcards

LA in the Maxilla Flashcards

1
Q

3 divisions of trigeminal nerve

A

Opthalamic, maxillary, mandibular

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2
Q

What are the major branches of V2

A

1) PSA
2) MSA
3) ASA
4) Greater Palatine Nerve
5) Nasopalatine
6) Infra-orbital Nerve

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3
Q

What are the maxillary injections

A

1) PSA
2) MSA
3) ASA
4) Greater Palatine Nerve Block
5) Nasopalatine Nerve Block
6) Infra-orbital Nerve Block
7) Supraperiosteal Injection (Local Infiltration)

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4
Q

What does MSA nerve innervate

A

Teeth - 1st PM, 2nd PM, partially 1st molar (sometimes MB cusp)

Tissue - buccal gingiva in premolar/1st molar regions

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5
Q

Target area and penetration of MSA nerve block

A

Target Area:
-slightly apical to the premolars either 1st or 2nd

Penetration of the mucosa is made:
-Along the long axis of the premolar
-To the apex of the premolar

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6
Q

What needle length for MSA and how much of needle do you insert

A

27 short

Insertion made to 1/3 to half length of needle - 1/4” to 1/2”

Bevel is towards bone

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7
Q

How many carpules for MSA

A

0.9-1.0 cc

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8
Q

Why is bevel towards bone

A

Can catch periosteum and it hurts if not

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9
Q

What does PSA innervate

A

Teeth - 3rd, 2nd and 1st molars (1st also somewhat by MSA)

Tissue - buccal gingiva in molar regions

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10
Q

What is the target area and penetration of mucosa PSA

A

Target area is:
-Apical to the root of the 3rd molar

Penetration of the mucosa is made:
-Just lateral to the 2nd molar
-At a 45 degree angle to the long axis of the tooth
-At an angle approaching 45 degrees medially

**avoid the pterygoid plexus

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11
Q

What must you avoid in PSA

A

Pterygoid plexus

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12
Q

What needle length and how much do you insert it for PSA

A

27 short

Insertion made to half needle length - 5/8”

Bevel towards bone

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13
Q

How much carpule for PSA

A

0.9-1.0 cc

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14
Q

What does ASA innervate

A

Teeth - canine, lateral and central incisor

Tissue - labial mucosa and inner aspect of lip to mid-line

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15
Q

What is the target area and penetration of ASA nerve

A

Target area:
-Apical and slightly distal to the canine

Penetration of the mucosa is made:
-Along the long axis of the canine
-To the target zone

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16
Q

What needle is used for ASA and how much do you insert

A

27 short

Insertion made to about 1/3 to half needle length - 1/4” to 3/8 “

Pull lip tight, bevel towards bone

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17
Q

How much carpule for ASA

A

1/2 carpule

0.9-1.0 cc

18
Q

What does greater palatine nerve innervate

A

No teeth

Tissues - palatal soft tissue from distal of canine to junction of hard and soft palate and medial to midline (same area of palatal bone)

19
Q

What is another name for greater palatine nerve block

A

Anterior palatine nerve block

20
Q

What is target area and penetration for greater palatine nerve block

A

Target area:
-The greater palatine foramen

Penetration of the mucosa is made:
-Just anterior to the greater palatine foramen
-1/2” medial to the disto-palatal cusp of the 2nd molar
-Needle positioned nearly perpendicular to mucosa

21
Q

What needle length and insertion is for greater palatine nerve block

A

27 short needle
Insertion until bevel is buried (1/4”)

Bevel is pointed laterally towards soft tissue

22
Q

What is technique for greater palatine nerve block

A

-Cotton tip applicator is used to locate GP foramen –> tissue ticker, pt discomfort
-Apply pressure to cotton tip applicator until tissue blanches (applicator perpendicular to bone)
-Keep pressure on applicator during penetration and first couple of drops –> ease pressure as anesthetic is delivered

23
Q

How much carpule for greater palatine nerve block

A

1/4 carpule - 0.25 cc
*until tissue blanches

24
Q

What does nasopalatine nerve innervate

A

No teeth

Tissue - palatal soft tissue, anterior portion of hard palate from distal of canine to distal of canine (same area of palatal bone)

25
Q

What is another name for nasopalatine nerve

A

Incisive nerve block

26
Q

What needle length and insertion for nasopalatine nerve block

A

27 short needle

Insertion until bevel is buries - about 1/8”

Bevel is towards bone

27
Q

What is target area and penetration for nasopalatine nerve block

A

Target area:
-Incisive foramen

Penetration of the muscoa is made:
-Just lateral to the incisive papilla - toward the posterior portion of the papilla
-At a 45 degree angle to the palatal bone

28
Q

What is technique for nasopalatine nerve block

A

-Apply pressure to cotton tip applicator on the Incisive Papilla until tissue blanches
-Keep pressure on applicator during penetration and first couple of drops –> ease pressure as anesthetic is delivered

29
Q

How many carpule for nasopalatine block

A

1/4 carpule - 0.25 cc

** until tissue blanches

30
Q

What is innervated by infraorbital nerve

A

Teeth - canine, incisors (to midline), 75% premolars and part of 1st molar

Tissues - buccal gingiva associated with teeth affected
Skin - lower eyelid, upper lip, lateral nose

31
Q

What needle length and innervation for infraorbital nerve block

A

25 long or 27 short needle

Insertion until bone is contacted - about half the needle length - 16mm

Bevel is towards bone

32
Q

What is target area and penetration of mucosa for infraorbital nerve block

A

Target area:
-Near the infraorbital foramen
-Inferior to the orbital rim

Penetration of the mucosa is made:
-Parallel to the 1st premolar
-Angle toward the infraorbital foramen

33
Q

How many carpule for infraorbital nerve block

A

3/4 carpule

0.9-1.2 cc

34
Q

What is another name for Supraperiosteal injection

A

Local infiltration

35
Q

What is supraperiosteal injection used for

A

Used in maxilla for pulpal anesthesia of 1-2 teeth
Soft tissue anesthesia of limited area

  • high success rate - 95%
36
Q

What needle length and insertion is for supraperiosteal injection

A

27 short needle

Insertion made at height of mucogingical fold - needle advanced to apical region of tooth

Bevel towards bone

37
Q

What is the target area and penetration for supraperiosteal injection

A

Target area:
-Apical region of the tooth to be anesthetized

Penetration of the mucosa is made:
-Along the long axis of the maxillary tooth
-To the target zone

38
Q

How many carpule for supraperiosteal injection

A

1/3 carpule

0.6 cc

39
Q

How should you recap needle

A

1 handed always * do not use non-dominant hand at all! You will stab yourself!

40
Q

What is syringe preparation

A

Engage the harpoon into the stopper with gentle but firm pressure on the thumb ring until the harpoon is FLUSH with the rubber

Do not exert extreme force

41
Q

How do you unload syringe

A

Take re-capped syringe to sharps container –> unscrew needle to remove WHILE holding the carboard –> discard needle only in sharps container by pushing capped end through carboard

*do NOT re-cap penetrating end of needle
*use cotton pliers for removing syringe needle from hub or stopper from harpoon

Pain and Anxiety (12 decks)

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