Techniques of Maxillary Anesthesia 2019 PDF

Oral and Maxillofacial Surgery & Diagnostic Sciences Department OMFS 311 Course Director: Dr. Nedal Abu Mostafa. Assistant Professor of Oral and Maxillofacial Surgery DR. NEDAL ABU MOSTAFA 1 Submucosal Topical Supraperiosteal Sub-periosteal Infiltration Intra-osseous Intra-septal Local An...

Oral and Maxillofacial Surgery & Diagnostic Sciences Department OMFS 311 Course Director: Dr. Nedal Abu Mostafa. Assistant Professor of Oral and Maxillofacial Surgery DR. NEDAL ABU MOSTAFA 1 Submucosal Topical Supraperiosteal Sub-periosteal Infiltration Intra-osseous Intra-septal Local Anesthesia in Maxilla Field block Intra-ligamintary Posterior superior alveolar Nerve block Anterior and Middle superior alveolar Greater palatine Incisive canal DR. NEDAL ABU MOSTAFA 2 Infiltration DR. NEDAL ABU MOSTAFA 3 Supra-periosteal injection (para-periosteal) Supra-periosteal injection (in the buccal vestibule) is the most frequently used technique in the maxilla. Area anesthetized: pulp, bone, buccal periosteum and mucous membrane. DR. NEDAL ABU MOSTAFA 4 Contraindication: infection or acute inflammation in the area of injection. Disadvantages: for treatment of multiple teeth: 1. Multiple injections and penetration of soft tissue needed. 2. Multiple injection increase the volume of L.A administrated that increases the risk of toxicity. DR. NEDAL ABU MOSTAFA 5 Technique: A 25-27 gauge Short needle. Area of insertion: height of the mucobuccal fold above the apex of the tooth. Clean the area with dry sterile gauze. Apply topical antiseptic (optional). For all injections Apply topical anesthesia. Insert the needle 45 degree, the syringe parallel with the long axis of tooth.. The bevel toward bone. Inject slowly one third of the cartridge (0.6 ml). DR. NEDAL ABU MOSTAFA 6 Failure of anesthesia: 1. The injection is far away from the apex, coronal to it (below the apex in maxillary teeth ). 2. The injection is too far into the buccal soft tissue. DR. NEDAL ABU MOSTAFA 7 Palatal anesthesia Sub-periosteal injection The palatal muco-periosteum is firm in consistency and is closely adapted to the bone. Therefore the Sub-periosteal injection will be performed under pressure. The patient should be warned prior to injection that it cause discomfort or pain. DR. NEDAL ABU MOSTAFA 8 Avoid injection solution too close to the greater palatine foramen as the lesser palatine nerve may be affected. This will produce anesthesia of the soft palate, tonsillar and uvular area. Direct injection to the palatal foramina should be avoided due to the risk of damage the nerve and intravascular injection. Palatal injections should never be given posterior to the second molar tooth. DR. NEDAL ABU MOSTAFA 9 Indication: surgical (tooth extraction) or any dental procedure may cause trauma to palatal soft and hard tissue such as: rubber dam application, retraction cord, matrix band… Contraindication: infection or acute inflammation in the area of injection DR. NEDAL ABU MOSTAFA 10 Technique: Site of injection: half away between the midline of the palate and gingival margin. (6-10) mm below gingival margin. Apply topical anesthesia on the injection site for 2 minutes. Insert the needle with the bevel facing the bone as near as possible at right angle to the palate on the estimated position of the apex of the tooth. Slow deposition of the local anesthetic DR. NEDAL ABU MOSTAFA 11 Nerve block DR. NEDAL ABU MOSTAFA 12 Posterior superior alveolar nerve block. (Tuberosity block) Nerve anesthetized: Posterior superior alveolar nerve. Area anesthetized : The pulp, buccal periodontium and bone of upper third, second and first molars. The mesial root of the first molar may need additional anesthesia because it may be innervated by middle superior alveolar nerve. DR. NEDAL ABU MOSTAFA 13 Indications: 1. Treatment of two or more maxillary molars. 2. When Supra-periosteal injection is contraindicated. Complication: Hematoma formation due to trauma to Pterygoid Venous Plexus. DR. NEDAL ABU MOSTAFA 14 Technique: Target area: posterior to the maxilla at the site of path of posterior superior alveolar nerve ( before it pass through the bone). Area of insertion: height of the mucobuccal fold above the maxillary second molar. Insert the needle ( in one movement) :upward 45-degree angle to occlusal plane, Inward and backward. In an adult of normal size, penetration to a depth of 16 mm DR. NEDAL ABU MOSTAFA 15 DR. NEDAL ABU MOSTAFA 16 1, Maxillary nerve 2, posterior superior alveolar branches. DR. NEDAL ABU MOSTAFA 17 Anterior superior alveolar nerve block (Infra-orbital nerve block) Nerves anesthetized: 1. Anterior superior alveolar nerve. 2. Middle superior alveolar nerve. 3. Infra-orbital nerve. Area anesthetized: 1. Pulps of maxillary incisors, canine, premolars and mesial root of the first molar. 2. The buccal periodotium and bone of these teeth. 3. The lower eyelid, lateral aspect of the nose and upper lip. DR. NEDAL ABU MOSTAFA 18 DR. NEDAL ABU MOSTAFA 19 Indications: 1. Treatment of two or more maxillary teeth (from central incisor up to second premolar). 2. When supra-periosteal injection is contraindicated. DR. NEDAL ABU MOSTAFA 20 Technique: Target area: infraorbital foramen. Area of insertion: height of the mucobuccal fold directly over the maxillary first premolar. Locate the infraorbital foramen and maitain your finger on it. Retract the lip. Insert the needle into the height of the mucobuccal fold parallel to the premolar. The approximate depth of needle penetration will be 16 mm (half the length of long needle). Aspirate. Deposit 0.91.2 ml (half to two third the cartridge) close to the foramen. DR. NEDAL ABU MOSTAFA 21 Innervations of the palate DR. NEDAL ABU MOSTAFA 22 Greater palatine nerve block Nerve anesthetized: Greater palatine nerve. Area anesthetized: The posterior part of the hard palate and its overlying soft tissues, anteriorly up to the first premolar and medially to the midline. DR. NEDAL ABU MOSTAFA 23 Indications: 1. When palatal anesthesia is required for more than two teeth. 2. When Sub-periosteal injection is contraindicated due to infection or acute inflammation. DR. NEDAL ABU MOSTAFA 24 Technique: Target area: greater palatine nerve when it pass anteriorly between soft tissue and bone. Area of insertion: soft tissue slightly anterior to greater palatine foramen. (The foramen frequently locates distal to maxillary 2nd molar). Path of insertion: advance the syringe from the opposite side of the mouth at right angle to the target area. The bevel toward the palatal soft tissue. DR. NEDAL ABU MOSTAFA 25 Nasopalatine nerve block (Incisive canal nerve block) Nerve anesthetized: Nasopalatine nerve bilaterally. Area anesthetized: The anterior part of the hard palate and its overlying soft tissues, from the mesial of the right first premolar to the mesial of the left first premolar. DR. NEDAL ABU MOSTAFA 26 Technique: Target area: incisive foramen beneath the incisive papilla. Area of insertion: palatal mucosa just lateral to the incisive papilla (locates in the midline behind the central incisors) Path of insertion: 45 degree angle toward the incisive papilla. The bevel toward the soft tissue DR. NEDAL ABU MOSTAFA 27 Maxillary Nerve Block Nerve anesthetized: Maxillary division of the trigeminal nerve. DR. NEDAL ABU MOSTAFA 28 Technique (High-Tuberosity Approach) Area of insertion: height of the mucobuccal fold above the distal aspect of the maxillary second Molar DR. NEDAL ABU MOSTAFA 29 Technique (Greater Palatine Canal Approach): Area of insertion: palatal soft tissue directly over the greater palatine foramen DR. NEDAL ABU MOSTAFA 30