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Questions and Answers
What is the recommended depth of needle insertion for average adults during the PSANB technique?
What is the recommended depth of needle insertion for average adults during the PSANB technique?
What volume of anesthetic solution is typically deposited during the PSANB procedure?
What volume of anesthetic solution is typically deposited during the PSANB procedure?
Which of the following clinical tests is NOT used to assess the effectiveness of the PSANB?
Which of the following clinical tests is NOT used to assess the effectiveness of the PSANB?
Why is the PSANB technique considered to be atraumatic for patients?
Why is the PSANB technique considered to be atraumatic for patients?
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What is the expected time frame after administering PSANB before dental treatment can commence?
What is the expected time frame after administering PSANB before dental treatment can commence?
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What is another commonly used name for the Posterior Superior Alveolar Nerve Block?
What is another commonly used name for the Posterior Superior Alveolar Nerve Block?
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Which structures are anesthetized by the Posterior Superior Alveolar Nerve Block (PSANB)?
Which structures are anesthetized by the Posterior Superior Alveolar Nerve Block (PSANB)?
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What is the key goal when performing the Posterior Superior Alveolar Nerve Block?
What is the key goal when performing the Posterior Superior Alveolar Nerve Block?
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Which area is NOT typically anesthetized by the PSANB?
Which area is NOT typically anesthetized by the PSANB?
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What indication suggests the use of a Posterior Superior Alveolar Nerve Block?
What indication suggests the use of a Posterior Superior Alveolar Nerve Block?
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What is one of the risks associated with the buccal mandibular region when administering the posterior superior alveolar nerve block?
What is one of the risks associated with the buccal mandibular region when administering the posterior superior alveolar nerve block?
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Which technique adjustment is recommended if the needle is too lateral during the injection?
Which technique adjustment is recommended if the needle is too lateral during the injection?
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What complication arises if the needle is inserted too far posteriorly during the procedure?
What complication arises if the needle is inserted too far posteriorly during the procedure?
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What is a disadvantage of the posterior superior alveolar nerve block technique?
What is a disadvantage of the posterior superior alveolar nerve block technique?
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What happens if there is bleeding in the buccal tissues after a mandibular anesthesia procedure?
What happens if there is bleeding in the buccal tissues after a mandibular anesthesia procedure?
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What is the primary reason the anterior superior alveolar nerve block (ASA) is less commonly used than the posterior superior alveolar nerve block (PSA)?
What is the primary reason the anterior superior alveolar nerve block (ASA) is less commonly used than the posterior superior alveolar nerve block (PSA)?
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In which situation is the anterior superior alveolar nerve block indicated?
In which situation is the anterior superior alveolar nerve block indicated?
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Which of the following structures is NOT innervated when administering an anterior superior alveolar nerve block?
Which of the following structures is NOT innervated when administering an anterior superior alveolar nerve block?
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What anatomical landmark is important for successfully administering an infraorbital nerve block?
What anatomical landmark is important for successfully administering an infraorbital nerve block?
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What percentage of the population has the middle superior alveolar nerve present?
What percentage of the population has the middle superior alveolar nerve present?
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What is the expected clinical finding during the probing test after an Intra-Oral Anterior Superior Alveolar Nerve Block?
What is the expected clinical finding during the probing test after an Intra-Oral Anterior Superior Alveolar Nerve Block?
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Which of the following could cause failure of the Anterior Superior Alveolar Nerve Block?
Which of the following could cause failure of the Anterior Superior Alveolar Nerve Block?
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What is one of the recommended corrections if the needle contacts bone during the procedure?
What is one of the recommended corrections if the needle contacts bone during the procedure?
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Which symptoms might occur as a complication of the Anterior Superior Alveolar Nerve Block?
Which symptoms might occur as a complication of the Anterior Superior Alveolar Nerve Block?
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What is a supplementary injection technique that can be used alongside the Intra-Oral Anterior Superior Alveolar Nerve Block?
What is a supplementary injection technique that can be used alongside the Intra-Oral Anterior Superior Alveolar Nerve Block?
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Study Notes
Maxillary Nerve Anatomy
- Branches within the cranium: middle meningeal nerve
- Branches within the pterygopalatine fossa:
- Zygomatic nerve: zygomaticotemporal nerve, zygomaticofacial nerve
- Pterygopalatine nerves: palatine branches (GP & LP nerves), nasal branches (NP nerve), orbital branches, pharyngeal branch
- Posterior Superior Alveolar (PSA) nerve
- Branches within the infra-orbital canal:
- Middle Superior Alveolar (MSA) nerve
- Anterior Superior Alveolar (ASA) nerve
- Branches on the face: inferior palpebral branches, external nasal branches, superior labial branches
Posterior Superior Alveolar Nerve Block (PSANB) Technique
- Also known as Zygomatic Block, Tuberosity Block
- Anesthetizes:
- PSA nerve
- Areas anesthetized:
- Buccal mucoperiosteum over maxillary molars
- Buccal and palatal alveolar plates of bone
- Periodontium of maxillary molars (except MB root of 1st molar)
- Pulps of maxillary molars (except MB root of 1st molar)
- Adjacent lining of the maxillary sinus
PSANB Technique
- Goal: Deposit local anesthetic close to PSA nerves, located posterosuperior and medial to the maxillary tuberosity
- Indications:
- Treatment involving two+ maxillary molars
PSANB Technique: Needle Insertion
- Landmarks:
- Mucobuccal fold, distal to the maxillary 2nd molar, slightly above occlusal plane
- Direction:
- Inward: medially at 45-degree angle towards midline & occlusal plane
- Upward: superiorly towards the maxillary tuberosity
- Depth:
- Average Adults: ¾ of short needle length (16 mm)
- Smaller Adults & Children: ½ of short needle length (10 mm)
PSANB Technique: Injection
- Aspiration test in two perpendicular planes
- Slow deposition of 0.9 ml (half-cartridge) up to 1.8 ml (full-cartridge) of anesthetic solution over 30 – 60 seconds
- Multiple aspirations during injection
PSANB Technique: Post-Injection
- Withdraw needle
- Recapp using single hand scoop technique
- Wait 3 to 5 minutes before treatment
PSANB Technique: Clinical Findings
- Subjective:
- Tingling and numbness
- Objective:
- Probing Test: No pain during probing of facial mucosa of maxillary molars
- Electrical Pulp Tester: No response with maximal EPT output (80/80)
- Freezing Spray: No response
- Absence of pain during treatment
PSANB Technique: Advantages
- High success rate (>95%)
- Atraumatic technique (minimal pain):
- Target area is loose connective tissue
- No bone contact
- One injection (vs. three infiltrations)
- Minimizes total anesthetic volume
PSANB Technique: Disadvantages
- Risk of diffuse intraoral hematoma in buccal mandibular region
- Arbitrary technique (no bony landmarks)
- Second injection may be required for first molar anesthesia (approximately 30%)
PSANB Technique: Causes of Failures & Complications
- Needle too lateral: Redirect medially
- Needle not high enough: Redirect superiorly
- Needle too far posterior: Withdraw to proper depth
PSANB Technique: Hematoma in Buccal Tissues of Mandibular Region
- Caused by:
- Inserting needle too far posteriorly
- May result in injury to pterygoid plexus of veins or perforation of maxillary artery
Anterior Superior Alveolar Nerve Block (ASANB) Technique
- Also known as Infraorbital Nerve Block
- Anesthetizes:
- ASA nerve
- MSA nerve (present in only 30% of population)
- Terminal branches of Infraorbital Nerve:
- Inferior palpebral: Lower eyelid
- Lateral nasal: Lateral aspect of the nose
- Superior labial: Upper lip
ASANB Technique: Applied Anatomy
- Anesthetic should enter infraorbital canal through infraorbital foramen
ASANB Technique: Advantages
- High success rate and safe when proper protocol followed
ASANB Technique: Indications
- Dental procedures involving two+ maxillary anterior teeth (incisors through premolars)
- When supraperiosteal injections have been ineffective due to dense bone
- Inflammation or infection (contraindicates supraperiosteal injection)
- Note: If cellulitis is present, a maxillary nerve block may be indicated instead of ASANB
ASANB Technique: Contraindications
- Severe infection in the region of the injection site
- Facial or orbital cellulitis
- Presence of congenital or acquired anatomical abnormalities
- Patients with hypersensitivity to local anesthetics
ASANB Technique: Intraoral Injection
- Landmarks:
- Mucobuccal fold, just apical to maxillary canine, between canine and lateral incisor
- Direction:
- Superiorly: Towards infraorbital foramen, approximately 45-degree angle
- Depth:
- About 15 mm (half needle length)
- Aspiration:
- Before and during injection
- Avoid injecting into blood vessels
- Volume:
- 0.9 ml (half-cartridge) to 1.2 ml (full-cartridge)
- Wait 3 to 5 minutes before treatment
ASANB Technique: Clinical Findings
- Subjective:
- Tingling and numbness of ipsilateral lower eyelid, side of nose, upper lip, teeth & soft tissues
- Objective:
- Probing Test: No pain during probing of facial mucosa
- Electric Pulp Tester: No response at maximal output
- Thermal Pulp Test: No response
- Absence of pain during treatment (e.g., cavity test)
ASANB Technique: Causes of Failures & Correction
- Needle contacting bone inferior to infraorbital foramen:
- Anesthesia of lower eyelid, side of nose, and upper lip may develop with little or no dental anesthesia
- Correction: Keep needle in line with infraorbital foramen, estimate depth before injection.
- Needle deviation medially or laterally to infraorbital foramen:
- Correction: Keep needle orientation toward foramen.
ASANB Technique: Alternative Techniques
-
Basic Injection Techniques:
- Infiltration technique
- Maxillary Nerve block
-
Supplementary Injection Techniques:
- Periodontal ligament Injection
ASANB Technique: Complications
- Hematoma across the lower eyelid
- Temporary double vision (horizontal diplopia)
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Description
Explore the intricate anatomy of the maxillary nerve and the techniques used for the Posterior Superior Alveolar Nerve Block (PSANB). This quiz covers the various branches of the maxillary nerve, their locations, and the specific areas anesthetized during the PSANB procedure. Perfect for dental students and professionals looking to enhance their understanding of maxillary nerve anatomy.
