Maxillary Local Anaesthetic Flashcards
What determines the choice of technique for maxillary anaesthesia?
Bespoke technique:
- patient, and their medical history
- nature, location and duration of planned procedure
- LA drug
What are the three main branches which supply the pulps of the maxillary teeth?
All branches of CN V2 maxillary division of trigeminal nerve:
- posterior superior alveolar nerve
- middle superior alveolar nere
- anterior superior alveolar nerve
What area do each of these nerves supply?
Incisive branch of naso-palatine: supplies soft tissues of palate around anterior teeth
Greater palatine nerve: soft tisues upto midline, and all posterior teeth on palate side
Lesser palatine: soft palate
List some key facts about infiltrations:
- easy and safe
- low risk of intravascular administration
- low risk of nerve injury
- local haemostasis
- local diffusion required
- acts on nerve ‘endings’ rather than trunk
- use a short needle (25mm - blue cap)
List some key points about regional blocks:
- can be difficult, less safe
- higher risk of IV administration
- higher risk of nerve injury
- acts on nerve trunk
- widespread effect from single injection
- can deposit away from infected area
What are infiltrations useful for?
Are there any difficulties and why?
- pulpal anaesthesia for most upper teeth
- soft tissue anaesthesia where you put it e.g. buccal/palatal
Can be difficult for:
- pulpal anaesthesia of upper 1st molars due to thicker bone (zygomatic buttress and/or divergent roots)
Spread of effect governed by ability of solution to diffuse - relatively localised anaesthesia
Describe an infiltration technique on a maxillary incisor:
- Identify site and dry with 3 in 1
- Apply topical gel on a cotton wool roll, leave for 3-5 minutes
- Remove cotton wool roll
- Deliver injection relatively quickly
- be efficient but dont rush
- retract soft tissues and hold taught
- have bevel facing the bone and syringe at 45 degrees to bone
- gently insert needle until you hit bone, then withdraw ~1mm, aspirate
- inject 1ml per minute, withdraw needle and wait
What is aspiration?
- technique to reduce the risk of intravascular injection leading to failure of LA and systemic side effects
- create negative pressure at the tip of the needle
- increase pressure inside cartridge
- then decrease pressure inside cartridge
- suction what is at needle tip into cartridge
Blood = in a vessel
Tips for giving pain free injections:
- use of topical tissue
- taught tissue - quick, precise needle penetration
- slow injection ~1ml/minute - drizzle
- 2 stage injection for upper anteriors
List some applications of block anaesthesia in the maxilla:
- mostly palatal block anaesthesia
- surgery invilving palatal soft tissues in a quadrant
- reduces dose compared to multiple palatal infiltrations
- more comfortable than multiple palatal infiltrations
What is the landmark for an incisive branch block?
Greater palatine?
Incisive branch: midline between central incisors and in line with canines
Greater palatine: imaginary line between upper 7 and 8 and a centimetre from gingival margin
