LA in the Maxilla Flashcards
3 divisions of trigeminal nerve
Opthalamic, maxillary, mandibular
What are the major branches of V2
1) PSA
2) MSA
3) ASA
4) Greater Palatine Nerve
5) Nasopalatine
6) Infra-orbital Nerve
What are the maxillary injections
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)
What does MSA nerve innervate
Teeth - 1st PM, 2nd PM, partially 1st molar (sometimes MB cusp)
Tissue - buccal gingiva in premolar/1st molar regions
Target area and penetration of MSA nerve block
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
What needle length for MSA and how much of needle do you insert
27 short
Insertion made to 1/3 to half length of needle - 1/4” to 1/2”
Bevel is towards bone
How many carpules for MSA
0.9-1.0 cc
Why is bevel towards bone
Can catch periosteum and it hurts if not
What does PSA innervate
Teeth - 3rd, 2nd and 1st molars (1st also somewhat by MSA)
Tissue - buccal gingiva in molar regions
What is the target area and penetration of mucosa PSA
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
What must you avoid in PSA
Pterygoid plexus
What needle length and how much do you insert it for PSA
27 short
Insertion made to half needle length - 5/8”
Bevel towards bone
How much carpule for PSA
0.9-1.0 cc
What does ASA innervate
Teeth - canine, lateral and central incisor
Tissue - labial mucosa and inner aspect of lip to mid-line
What is the target area and penetration of ASA nerve
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
What needle is used for ASA and how much do you insert
27 short
Insertion made to about 1/3 to half needle length - 1/4” to 3/8 “
Pull lip tight, bevel towards bone
How much carpule for ASA
1/2 carpule
0.9-1.0 cc
What does greater palatine nerve innervate
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)
What is another name for greater palatine nerve block
Anterior palatine nerve block
What is target area and penetration for greater palatine nerve block
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
What needle length and insertion is for greater palatine nerve block
27 short needle
Insertion until bevel is buried (1/4”)
Bevel is pointed laterally towards soft tissue
What is technique for greater palatine nerve block
-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
How much carpule for greater palatine nerve block
1/4 carpule - 0.25 cc
*until tissue blanches
What does nasopalatine nerve innervate
No teeth
Tissue - palatal soft tissue, anterior portion of hard palate from distal of canine to distal of canine (same area of palatal bone)
What is another name for nasopalatine nerve
Incisive nerve block
What needle length and insertion for nasopalatine nerve block
27 short needle
Insertion until bevel is buries - about 1/8”
Bevel is towards bone
What is target area and penetration for nasopalatine nerve block
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
What is technique for nasopalatine nerve block
-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
How many carpule for nasopalatine block
1/4 carpule - 0.25 cc
** until tissue blanches
What is innervated by infraorbital nerve
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
What needle length and innervation for infraorbital nerve block
25 long or 27 short needle
Insertion until bone is contacted - about half the needle length - 16mm
Bevel is towards bone
What is target area and penetration of mucosa for infraorbital nerve block
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
How many carpule for infraorbital nerve block
3/4 carpule
0.9-1.2 cc
What is another name for Supraperiosteal injection
Local infiltration
What is supraperiosteal injection used for
Used in maxilla for pulpal anesthesia of 1-2 teeth
Soft tissue anesthesia of limited area
- high success rate - 95%
What needle length and insertion is for supraperiosteal injection
27 short needle
Insertion made at height of mucogingical fold - needle advanced to apical region of tooth
Bevel towards bone
What is the target area and penetration for supraperiosteal injection
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
How many carpule for supraperiosteal injection
1/3 carpule
0.6 cc
How should you recap needle
1 handed always * do not use non-dominant hand at all! You will stab yourself!
What is syringe preparation
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
How do you unload syringe
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
