Maxillary Anaesthesia Flashcards
Name the branches of V2 relevant to maxillary anaesthesia
Posterior superior alveolar; middle superior alveolar; anterior superior alveolar; infraorbital
What does the posterior superior alveolar nerve numb when anaesthetised?
the molars - excluding the mesio-buccal root of U6.
What does the middle superior alveolar nerve numb when anaesthetised?
the premolars and the mesio-buccal root of U6.
What does the anterior superior alveolar nerve numb when anaesthetised?
the ipsilateral incisors and canine
Name the nerves of the palate relevant to maxillary anaesthesia
Incisive branch of nasopalatine nerve
Greater palatine nerve
Lesser palatine nerve
What does the incisive branch of nasopalatine nerve numb when anaesthetised?
palatal mucosa around maxillary 3-3 (in a wee triangle)
What does the greater palatine nerve numb when anaesthetised?
palatal mucosa of hard palate from 4-8
What does the lesser palatine nerve numb when anaesthetised?
soft palate
What are the uses of topical anaesthesia?
aid to pain-free injections
very minor surgical procedures
abscess incision
rubber dam clamps
How long does topical anaesthesia gel take to act?
2-5 mins
What needle is used for maxillary infiltrations?
25 mm (short), 30 gauge
What is the LA solution used for maxillary infiltrations?
2.2ml of 2% lidocaine hydrochloride with 1:80,000 adrenaline
What is the aim of maxillary infiltrations?
deposition and diffusion of LA solution close to or in the target tissue
Where do infiltrations using lidocaine work best?
Thin porous bone i.e. in the maxilla or anterior mandible
Where do infiltrations using lidocaine not work and what is the alternative?
Very dense cortical bone i.e. the posterior mandible, 4% articaine infiltrations often do work
Where can it be difficult for infiltrations using lidocaine to work?
thicker bone due to zygomatic process, divergent roots (upper 1st molars)
What are maxillary infiltrations used for?
pulpal for most upper teeth and soft tissue anaesthesia where you deposit the LA solution
What can maxillary infiltrations be difficult for?
Pulpal anaesthesia of upper 1st molars - due to thickened bone for zygomatic process and possibly because of divergent roots
What must be done prior to injection?
Injection site must be dried with 3 in 1 and topical LA gel applied on cotton wool roll for 2-5 mins
What should be used for soft tissue retraction for maxillary infiltrations?
dental examination mirror to decrease chances of needle stick injury for practioner
Where should the bevel of the needle be facing?
BEVEL TO BONE
What angle should needle be at to the bone?
approx 45 degrees
How much La solution should be deposited and how quickly?
1ml a minute (SLOWLY)
What does slow deposition of LA solution do?
less painful for patient
Why are palatal infiltrations often more uncomfortable for the patient?
Not much space between soft tissue and bone for LA to go
What distraction technique can be used to lessen the discomfort in the palate?
Use the end of the mirror near injection site to trick brain
When would maxillary blocks be useful?
Surgery involving palatal soft tissues in quadrant
What is the most common maxillary block?
Palatal block - incisive or greater palatine
Why would maxillary blocks be use?
Reduces dose cf. multiple palatal infiltrations
More comfortable than multiple palatal infiltrations
