Techniques of max anesthesia

Question 1

what are the type of max nerve blocks?

Answer 1

PSA, ASA, MSA
palatal (nasopalatine, greater palatine)if
second division (V2)

Question 2

what’s another name for local infiltration?

Answer 2

supraperiosteal injection

Question 3

T/F getting the second division (V2) numb will get the rest of the max nerve blocks as well

Answer 3

true

Question 4

T/F infra-orbital gives dental innervation

Answer 4

False
infra-orbital gets soft tissue numb, but not dental innervation and is useful for incision and drainage

Question 5

1st max molar entire tooth ______% of the time
and not the MB root ______% of the time with PSA

Answer 5

72%, 28%

Question 6

what are the PSA landmarks?

Answer 6

distal to the malar process
45 deg to the mesiodistal plane
45 deg to the buccolingual plane
15-16 depth of penetration

Question 7

what are the nerves anesthetized with the ASA

Answer 7

ant superior alveolar
MSA (72% of the time)
infraorbital nerve

Question 8

T/F ASA will hit the lower eyelid, lateral nose, and upper lip

Answer 8

true

Question 9

where should you do the ASA penetration?

Answer 9

over the max 1st premolar

Question 10

what is the penetration depth for ASA

Answer 10

15mm

Question 11

how much cc’s with ASA after aspiration

Answer 11

1.0

Question 12

where do you put pressure/massage with ASA?

Answer 12

into infra-orbital foramen

Question 13

_______% of the time a pt has a separate MSA nerve present

Answer 13

28%

Question 14

_______% of the time that a pt has a MSA be a branch of the ASA

Answer 14

72%

Question 15

where would you inject for the MSA

Answer 15

over the max 2nd premolar at the height of ht ebuccal vestibule

Question 16

what’s the penetration length for MSA

Answer 16

15mm

Question 17

where will the nasoplaltine nerve block get numb?

Answer 17

the palatal soft tissue canine to canine (the “pre-maxilla”)

Question 18

where should you inject for the anterior approach for the nasopalatine nerve block?

Answer 18

anesthetize the facial aspect of central incisors - infiltrate buccal mucosa
interseptal infiltration b/t 8-9 progressing from facial to palatal
inject incisive papilla (usually painlessly)

Question 19

where is the greater palatine usually located?

Answer 19

just distal to the 2nd molar (b/w junction of the max alveolar process and the hard palate)

Question 20

where will the greater palatine injection anesthetize?

Answer 20

palatal soft tissue from 1st premolar to midline of side injected

Question 21

where will the second division get numb?

Answer 21

hemi-maxilla
-pulpal anesthesia of that side
-bone: alveolar and palatal of that side
-tissue: buccal, hard palate, some soft palate
-skin: infraorbital distribution

Question 22

what is the needle at approx to enter canal for the greater palatine approach to hit the 2nd division?

Answer 22

45 degrees

Question 23

how far do you advance for the greater palatine approach to get V2 numb?

Answer 23

30 mm

Question 24

what percentage of the greater palatine approach for V2 block fail to negotiate?

Answer 24

5-15%

Question 25

where and how far do you go for the high tuberosity approach to get V2 numb?

Answer 25

PSA: 15-16mm
high tuberosity second division: 30mm

Question 26

at 30mm where should the needle lie for the high tuberosity approach for V2 block?

Answer 26

pterygopalatine fossa