Regional Anesthesia for Dentistry

Question 1

describe the maxillary nerve
-there is an ibook for all this!

Answer 1

1. provides sensory innervation to the maxillary teeth, hard and soft palate, the nose, and the lower eyelids
2. exits cranium via round foramen, coursing into the pterygopalatine fossa
3. enters the infraorbital canal via maxillary foramen

Question 2

describe the infraorbital approach to the maxillary nerve

Answer 2

1. insert catheter through infraorbital canal to an appropriate depth based on the patient’s confirmation
2. local anesthetic deposited on opposite side of infraorbital canal
3. pros:
   -most accurate
   -safest! minimal risk of puncturing important structures in pterygopalatine fossa
4. cons:
   -deposits local anesthetic in a more cranial locations (not far enough back to block most caudal molar)

Question 3

describe the lateral approach to the maxillary nerve

Answer 3

1. insert needle on ventral aspect of rostral half of zygomatic arch, directing needle slightly rostrally
2. advance needle into pterygopalatine fossa and deposit local anesthetic
3. pros: technically easy and likely to block the most caudal molar
4. cons:
   -potential for damage to salivary gland and maxillary artery
   -perpendicular approach to nerve = greater risk of injury

Question 4

describe the intraoral approach to the maxillary nerve

Answer 4

1. use a short needle, advance dorsally just caudal to maxillary tuberosity
2. pros:
   -may block more caudally than infraorbital approach (most caudal molar)
   -technically easy to perform
3. cons:
   -may penetrate orbit
   -possible damage to salivary gland and maxillary artery/nerve

Question 5

describe the mandibular/inferior alveolar nerve

Answer 5

1. provides sensory innervation to the mandibular teeth
2. exits the cranium via the oval foramen and courses over the medial aspect of the temporomandibular joint
3. gives rise to lingual nerve
   -DONT want to block or patient will chew their tongue off
4. courses along lateral aspect of the medial pterygoid muscle toward the mandibular foramen, where it becomes the inferior alveolar nerve
5. inferior alveolar enters the mandibular foramen

Question 6

describe the intra-oral approach to the inferior alveolar nerve

Answer 6

1. open mouth as wide as possible, palpate mandibular nerve on medial aspect of the ventral portion of the ramus of the mandible

2, advance needle into mucosa and direct tip of the needle over the mandibular foramen, deposit

3. pros:
   -can palpate and visualize appropriate placement of local anesthetic
4. cons:
   -patient must be able to open mouth

Question 7

describe the extra-oral approach to the inferior alveolar nerve

Answer 7

1. needle inserted on the medial aspect of the mandible advancing dorsally toward the mandibular foramen
2. appropriate distance can be estimated based on confirmation or the needle can be palpated moving along the ramus of the mandible
3. local anesthetic deposited over mandibular foramen
4. pros: mouth can remain closed
5. cons: less accurate than intraoral (could anesthetize some of the lingual nerve and cause tongue chewing