Landmarks for Local Anesthia- Part of CUM FINAL Flashcards
type of injection that anesthetizes a small area—one or two teeth and associated structures—when the local anesthetic agent is deposited near terminal nerve endings
Local infiltration
type of injection that
anesthetizes a larger area than a local
infiltration because the local anesthetic is
deposited near large nerve trunks
Nerve block
abnormal sensation from an
area such as burning or prickling
Paresthesia
Bones involved in Local Anesthia are
maxilla
palatine
mandible
Soft tissues will serve as ____ _____,
but due to variation among patients, you
must learn to rely mainly on visualization
and palpation of hard tissues
initial landmarks
The clinician must never progress the needle
through an area with an ______ ________ ________ to prevent spread of dental
infection. Effectiveeness is greatly reduced in areas administered
abscess, cellulitis, or
osteomyelitis
Why is local anesthia of the maxilla more successful than the mandible ?
- Bone over facial surface of max teeth is less dense than that of the mandible
- Less variation of anatomy of the maxillary and palatine bones with respect to landmarks than the mandible
PSA MSA ASA IO NP AMSA
Maxillary nerve anesthesia
Maxillary molar teeth and associated buccal tissues
PSA
Maxillary premolars and mesiobuccal root of 1st molar, and associated buccal tissues
MSA
Maxillary canine and incisors and associated facial tissues
ASA
Maxillary anterior and premolar teeth and associated facial tissues
Infraorbital IO
Palatal tissues distal to maxillary canine
GP
greater palatine
Palatal tissues between the right and left maxillary canines
NP
nasopalatine
The only injection that crosses the midline
Nasopalatine
Pulpal and soft tissue anesthia of large area covered by ASA, MSA, GP and NP
Anterior Middle Superior Alveolar AMSA
PSA Target Area
PSA nerve as it enters the maxilla through the posterior superior alveolar foramina on the maxilla’s infratemporal surface
PSA penetration site
Height of the mucobuccal fold at the apex of the maxillary second molar, distal to the zygomatic process of the maxilla
In some patients, the MB root of the first molar is not innvervated by the PSA, but by the ___ , a second injection may be necessary
MSA
PSA must avoid injecting into the
pteryoid plexus
MSA Target Area
MSA nerve at the apex of the maxillary second premolar
Penetration site of MSA
-Penetration site: Height of mucobuccal fold at the
apex of the maxillary
second premolar
-Needle is inserted until its tip is located superior to the apex of the maxillary second premolar without touching the bone
Possible complications of MSA
Over-insertion complications such as a
hematoma are rare with the MSA
ASA target area:
ASA nerve at the apex of the maxillary canine
Penetration site ASA
Penetration site: tissues at the height of the mucobuccal fold at the apex of the maxillary canine, just anterior to and parallel with the canine eminence.
Possible complications of ASA
over insertion with complications like a hematoma are rare with the ASA
-Anesthetizes MSA and ASA nerves (max. premolars, canine, and incisors and supporting structures)
-Ta r g e t a r e a :
infraorbital foramen.
IO
IO penetration site:
height of the mucobuccal fold tissues at the apex of the maxillary first premolar.
IO possible complications
May get a hematoma across lower eyelid and tissues between it and the infraorbital foramen
GP/Greater Palatine Target Area
anterior to where the nerve exits the greater palatine foramen, at the junction of the alveolar process and hard palate
GP penetration site:
anterior to depression created by the greater palatine foramen. The depression can be palpated about midway between the palatine raphe and the lingual gingival margin.
KEYS for greater palatine injection
Because overlying tissue is firmly adhered to the palatal bone, use pressure anesthesia posterior to the injection site to blanch tissues and reduce discomfort. Deposit the anesthetic SLOWLY!
Possible Complications of GP
soft palate may be
inadvertently anesthetized, which is
harmless, but may be uncomfortable for
patient who may gag
During the GP injection which nerve may be anesthetized causing soft palate anesthia
Lesser palatine/feels like cant swallow
Nasopalatine Block Target area
b o t h the right and left NP as they exit the incisive foramen, beneath the incisive papilla
NP Block Injection Site
palatal tissues
lateral to the incisive
papilla
Pressure anesthesia
is also applied, from
the contra lateral
side
Possible complications of NP
Complications such as a hematoma are extremely rare
AMSA
Anterior Middle Superior Alveolar Block
Target Area
Tissues of the hard palate between the apices of 1st and 2nd premolars
Anterior Middle Superior Alveolar Block AMSA Injection Site
an area bisecting the apices of the maxillary premolars, midway between lingual gingival margin and median palatal raphe
Possible complications of AMSA
blanching will be noted after the AMSA block. If blanching is excessive, there may be postoperative tissue ischemia and sloughing. Other complications are rare.
Inferior Alveolar Block (IA) Buccal Block (Long Buccal) Incisive Block Mental Block Gow Gates
These are all for
- Maxillary Nerve Anesthesia
- Mandibular Nerve Anesthia
Mandibular nerve anesthia
Target Area for Inferior Alveolar Block
slightly superior to the entry point of the IA nerve into the mandibular foramen ***LA must be acurately deposited within 1mm of the target area to achieve anesthesia*** Mainly hard tissues are used as landmarks, such as the coronoid notch and occlusal plane of mandibular teeth
When giving an IA the anesthetic must be acurately deposited within __ mm of the target areas to achieve anesthia
1mm
IA injection iste
Pterygomandibular space = portion of infratemporal space between medial pterygoid muscle and ramus
Possible Complications of IA
possible transient facial paralysis (if
facial nerve is mistakenly anesthetized—incorrect
injection of anesthetic into parotid gland); hematoma;
muscle soreness; paresthesia—usually from trauma to
the lingual nerve (rare)
Possible lingual shock can come from
- IA
- AMSA
- NP
IA
Buccal Block- Long Bucval Target Area:
buccal nerve located on the anterior border of the mandibular ramus
Long Buccal Block Penetration site
buccal tissues that are distal
and buccal to the most distal molar tooth in the
arch
Complications of Buccal are
rare
Incisive Block and Mental Block Target Area:
a n t e r i o r to the depression caused by the mental foramen, usually located at the height of the mucobuccal fold between the apices of the mandibular first and second premolars
Incisive Block and Mental Block
Penetration Site:
height of the mucobuccal fold tissues, between apices of first and second premolars The difference: Pressure is applied after the injection to force more LA into the foramen, anesthetizing both the shallow mental, and deeper incisive.
Complications of Mental and Incisive Blocks
RARE
Gow-Gates Target Area
anteromedial border of the mandibular condyle neck, just inferior to the insertion of the lateral pterygoid muscle
Gow-Gates Penetration site
soft tissues just distal to the maxillary second molar; vertical height of the injection is established using the height of the mesiolingual cusp of max 2nd molar; use an extraoral line for guidance (intertragic notch to ipsilateral labial commisure of the lip)
Possible Complications of Gow-Gates and disadvantages
- Complications: anesthesia of the lower lip (can lead to
trauma)
-Disadvantages: LA takes longer to take effect;
injection lasts longer, and a larger volume of anesthetic
may be necessary; trismus is possible
-Trismus = spasm of muscles making it difficult to open
Your patient needs a filling on #6.
Which of the following injections is most
appropriate?
ASA
SRP you need to anesthetize
a. Pulp
b. Soft tissue
BOTH
