Posterior Superior Alveolar Nerve Block Technique

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Questions and Answers

What is a primary advantage of using the anterior superior alveolar nerve block compared to the infiltration technique?

Requires more needle punctures

Has a shorter anesthetic effect

Provides complete hemostasis in the operative field

Minimizes the volume of solution used (correct)

What is the position of the patient during the administration of the anterior superior alveolar nerve block?

Supine or semisupine with neck slightly extended (correct)

Lying down on their side

Sitting upright with the head tilted back

Standing with feet flat on the ground

Which item is NOT part of the basic armamentaria for performing an anterior superior alveolar nerve block?

Long needle

Topical anesthetic applicator (correct)

Aspirating syringe

Local anesthetic cartridge ± VC

What is the primary reason for preparing the tissue at the site of injection for an anterior superior alveolar nerve block?

To facilitate a painless experience Signup and view all the answers

How is the infraorbital foramen located during the anesthetic procedure?

By feeling the infraorbital notch and applying pressure downward Signup and view all the answers

Which area is NOT anesthetized by the Posterior Superior Alveolar Nerve Block (PSANB)?

Periodontium of maxillary incisors Signup and view all the answers

Which nerve is primarily anesthetized by the PSANB technique?

Posterior superior alveolar nerve Signup and view all the answers

What is the main goal of the Posterior Superior Alveolar Nerve Block (PSANB) technique?

To deposit local anesthetic adjacent to the PSA nerves Signup and view all the answers

Which structure is located posterosuperior and medial to the maxillary tuberosity?

Posterior superior alveolar nerves Signup and view all the answers

What is one indication for using the Posterior Superior Alveolar Nerve Block (PSANB) technique?

Treatment of maxillary molars Signup and view all the answers

What is a contraindication for supraperiosteal injection?

Current infection at the injection site Signup and view all the answers

Where should the point of insertion be located for a posterior superior alveolar nerve block?

Height of the mucobuccal fold above the maxillary second molar Signup and view all the answers

What is the recommended needle orientation for inserting the needle during PSANB?

Upward at a 45-degree angle to the occlusal plane and backward at a 45-degree angle to the long axis of the second molar Signup and view all the answers

What is the likelihood of positive aspiration when performing a posterior superior alveolar nerve block?

3 % (High) Signup and view all the answers

Which of the following is NOT an armamentarium required for the PSANB technique?

Lidocaine topical gel Signup and view all the answers

What is the average penetration depth of the needle for an adult of average height?

16 mm Signup and view all the answers

What should be done if the needle is palpable during the procedure?

Withdraw and redirect the needle. Signup and view all the answers

How many times should aspiration be performed before administering local anesthetic?

Twice Signup and view all the answers

What is the purpose of exerting finger pressure over the infraorbital foramen?

To ensure localized diffusion of anesthetic. Signup and view all the answers

What is the recommended volume of local anesthetic to deposit using a 25-gauge long needle?

0.5 ml Signup and view all the answers

What indicates that the local anesthetic solution is being deposited correctly?

Feeling the anesthetic beneath the finger pad. Signup and view all the answers

What is the important step to take immediately after withdrawing the needle from the tissues?

Make the needle safe. Signup and view all the answers

Which orientation change should be made during the second aspiration test?

Rotate the syringe 45 degrees. Signup and view all the answers

What should be checked first if there is a failure of anesthesia during an anterior superior alveolar nerve block?

Needle contact with bone Signup and view all the answers

What is a common complication following the anterior superior alveolar nerve block?

Hematoma across the lower eyelid Signup and view all the answers

Which technique could be considered as an alternative if the anterior superior alveolar nerve block fails?

Maxillary nerve block Signup and view all the answers

What objective test indicates successful anesthesia during an anterior superior alveolar nerve block?

Absence of pain during treatment Signup and view all the answers

What is a potential outcome of needle deviation during the administration of an anterior superior alveolar nerve block?

Inadequate anesthesia of the upper lip Signup and view all the answers

Study Notes

Posterior Superior Alveolar Nerve Block (PSANB) Technique

Other names: Zygomatic Block, Tuberosity Block
Nerves Anesthetized: PSAN
Areas Anesthetized: Buccal mucoperiosteum over the maxillary molars, buccal and palatal alveolar plates of bone, Periodontium of maxillary molars except for the MB root of 1st molar, Pulps of maxillary molars except for the MB root of 1st molar, Adjacent lining of the maxillary sinus
Goal: Deposit local anesthetic close to the PSA nerves, located posterosuperior and medial to the maxillary tuberosity
Indications: Treatment procedure involving two or more maxillary molars, When supraperiosteal injection has proved ineffective, When supraperiosteal injection is contraindicated
Contraindications: Infection at the site of injection, when the risk of hemorrhage is too great
Positive Aspiration: 3% (High)
Alternatives: Supraperiosteal Infiltrations for PSAN, Maxillary nerve block
Armamentariums: Short Needle (Length: 20 mm) & 25- or 27-gauge, Aspirating Syringe, Local Anesthetic Cartridge (with or without Vasoconstrictor)
Point of insertion: Height of the mucobuccal fold above the maxillary second molar.
Target Area: PSAN as it enters the posterior surface of the maxilla (posterior, superior and medial) to maxillary tuberosity
Technique: Partially open the patient’s mouth, retract the patient’s cheek with a mouth mirror, pull the tissues at the injection site taut, insert the needle into the height of the mucobuccal fold over the second molar, advance the needle slowly in an upward, inward, and backward direction in one movement
Needle Orientation: Upward: superiorly at a 45-degree angle to the occlusal plane, Backward: posteriorly at a 45-degree angle to the long axis of the second molar

Anterior Superior Alveolar Nerve Block

Basic Armamentaria: Long Needle, Aspirating Syringe, Local Anesthetic cartridge ± VC
Auxiliary Armamentaria: Topical Antiseptic, Topical Anesthetic and its applicator, Hemostat & College Cotton Tweezer
Position of the Patient: Position the patient supine or semisupine with the neck extended slightly
Position of the Dentist (Right-Handed Dentist): The dentist should stand on the right side of the chair, The dentist should stand or sit directly facing the patient
Prepare the Tissue At The Site Of Injection: Dry with sterile gauze, Apply a topical antiseptic, Apply topical anesthetic for a minimum of 1 minute
Locate the infraorbital foramen: Feel the infraorbital notch, Move your finger downward from the notch, applying gentle pressure to the tissues, The bone immediately inferior to the notch is convex (felt as an outward bulge), Depth of Needle Penetration: The average penetration depth of needle for an adult of average height is 16 mm
Safety Measures: Advance the needle slowly until the bone is gently contacted, The needle must contact the bone at the roof (upper rim) of the infraorbital foramen, The needle should not be palpable
Aspiration It should be performed at least twice before the local anesthetic is administered, For the second aspiration test, rotate the syringe about 45 degrees
PRECAUTION TO PREVENT OVERINSERTION OF THE NEEDLE: Estimate the proper depth of penetration before injection, Be sure that the needle tip must contact the infraorbital rim of bone, Exert finger pressure over the infraorbital foramen
Intra-Oral Anterior Superior Alveolar Nerve Block - Amount of Required LA: Using a 25-gauge long needle, slowly deposit 0.9 ml (1/2 cartridge) up to 1.2 ml (2/3 cartridge) over 30 - 40 seconds, respectively
Intra-Oral Anterior Superior Alveolar Nerve Block - Completion of the Technique: Slowly withdraw the needle from the tissues, Immediately make the needle safe, Maintain direct finger pressure over the injection site for 1 – 2 minutes, Wait for 3 to 5 minutes before commencing the planned dental procedure
Clinical Findings: Subjective: Tingling and numbness of the ipsilateral lower eyelid, side of the nose, upper lip, teeth & soft tissues, Objective: Probing Test: absence of pain during probing of facial mucosa, Electric Pulp Tester: no response to maximal EPT output, Thermal Pulp Test using Freezing Spray: no response, Absence of pain during treatment
Causes For Failure of ASANB
- Needle contacting bone inferior to the infraorbital foramen, Needle deviation medial or lateral to the infraorbital foramen
Alternative Techniques: Infiltration technique, Maxillary Nerve block, Periodontal ligament Injection

Complications of ASANB

Hematoma Across The Lower Eyelid, Temporary Double Vision (Horizontal Diplopia)

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Description

Explore the intricacies of the Posterior Superior Alveolar Nerve Block (PSANB) technique, including its indications, contraindications, and areas affected. This quiz covers essential information for practitioners performing dental anesthesia effectively and safely, particularly for maxillary molars.