Maxillary Block Anesthesia PDF

Maxillary block anesthesia Dr. Mohammed Amjed Alsaegh BDS, MSc, PhD Oral & Maxillofacial Surgery 31/10/2023 1 CLO 3 Perform local anesthesia technique and intraoral suturing in a simulated condition Lecture objectives At the end of the lecture, you should know the principle of the following max...

Maxillary block anesthesia Dr. Mohammed Amjed Alsaegh BDS, MSc, PhD Oral & Maxillofacial Surgery 31/10/2023 1 CLO 3 Perform local anesthesia technique and intraoral suturing in a simulated condition Lecture objectives At the end of the lecture, you should know the principle of the following maxillary block techniques: • Posterior superior alveolar nerve block O O• Middle superior alveolar nerve block • Anterior superior alveolar nerve block O O• Infra orbital nerve block • Anterior middle superior alveolar nerve block o• Greater palatine nerve block • Nasopalatine (long sphenopalatine nerve) block O• Maxillary nerve block. UoS, Dr. Mohammed Amjed Alsaegh, 2023 2 Posterior superior alveolar nerve block (PSA) UoS, Dr. Mohammed Amjed Alsaegh, 2023 3 Posterior superior alveolar nerve block (PSA) Q Whatarethe Areas Anesthetized p 7 6 g 1. Pulps of the maxillary third, second, and first molars (entire tooth = 72%; mesiobuccal root of the maxillary first molar not anesthetized = 28%) • P.S.A nerve block will anesthetize the whole third and second molar and the rst molar except for the MB root 2. Buccal periodontium and bone overlying these teeth 48 - High success rate (>95%) NOTE • For extraction we need P.S.A nerve block + palatal in ltration • For lling no need to anesthetize the palate - Technique somewhat arbitrary: no bony landmarks during insertion Jain toes UoS, Dr. Mohammed Amjed Alsaegh, 2023 • “ i want you to know two things when we talk about block technique why?More ediffulct since its a pathway through teh tissue ◦Area of insertion is seen with your eyes + use light ◦Target area is not seen you need to imagine it, there are landmarks during injection which low you to 4 reach the target area Posterior superior alveolar nerve block (PSA) Maxillary nerve block has teh same entry point of PSA nerve block but goes 30 mm deep ( not 16mm) since its more posterior located Whats'fhrepsa Technique 7 111 t Area of insertion: height of the mucobuccal fold above the maxillary second molar upper seven? Because the needle is directed at Target area: PSA nerve—posterior, superior, Why and c l (angle of insertion) 45 degrees, after the insertion medial to the posterior border of the maxilla b b of needle 16 mm (depth of needle) then it reaches the target area posterior superior alveolar nerve Target area is the apical area near the bone for the tooth being anesthetized Gain Access - Partially open the patient's mouth, pulling the move to the side of injection mandible theneedle - Insert the needle into the height ThToinsert mucobuccal fold over the second molar A of the 450 Genter login when targeting postsuperiors alveolarnerveUoS, Dr. Mohammed Amjed Alsaegh, 2023 5 PSA my UoS, Dr. Mohammed Amjed Alsaegh, 2023 6 Posterior superior alveolar nerve block (PSA) -Advance the needle slowly in an upward, inward, and backward direction (1) Upward: superiorly at a 45-degree angle to the occlusal plane (2) Inward: medially toward the midline at a 45degree angle to the occlusal plane (3) Backward: posteriorly at a 45-degree angle to the long axis of the second molar f to the Are angles What advance the needles 450 depthofmthynestibule How'ayfthofpethntration f In an adult of normal size, penetration to a depth of 16 mm places the needle tip in the immediate vicinity of the foramina through which the PSA nerves enter the posterior E F surface of the maxilla. When a long needle is used (average length, 32 mm), it is inserted half its length into the tissue. With a short needle (average length, 20 mm), approximately 4 mm UoS, Dr. Mohammed Amjed Alsaegh, 2023 7 should remain visible. Posterior superior alveolar nerve block (PSA) more tve aspiration - Positive Aspiration Approximately 3.1%. EXQnwaswinho.me e aspiration - Slowly, over 30 to 60 seconds, deposit 0.9 to 1.8 mL of anesthetic solution. Q.WS ssthaetraEuntaE - The PSA injection is normally atraumatic because of [1] the large tissue space available to accommodate the anesthetic solution and the fact that [2] bone is not touched. UoS, Dr. Mohammed Amjed Alsaegh, 2023 8 UoS, Dr. Mohammed Amjed Alsaegh, 2023 9 Infraorbital nerve block UoS, Dr. Mohammed Amjed Alsaegh, 2023 10 Infraorbital nerve block Infraorbital nerve gives rise to: 1.Anterior superior 2.Middle superior ◦So these two are also anesthetized + other structured mentioned below 3. Anesthetizes the incisor central, lateral, k9, 4 + 5 premolars G Which Nerves Anesthetized 1. Anterior superior alveolar 2. Middle superior alveolar 3. Infraorbital nerve a. Inferior palpebral nerveClowereyelid b. Lateral nasal c. Superior labial Whatstructuresare Areas Anesthetized s 1. Pulps of the maxillary central incisor through the canine on the injected side 2. In about 72% of patients, pulps of the maxillary premolars were anesthetized 3. Buccal (labial) periodontium and bone of these same teeth MMM 4. Lower eyelid, lateral aspect of the nose, upper lip UoS, Dr. Mohammed Amjed Alsaegh, 2023 11 Q. What is the technique of infraorbital nerve block? Go to upper 5 or 4 or between Palpitate the infraorbital foramen to identify it amd move ito under infra orbital margin theres a depression Insert needle parallel to the tooth until you tooth infraorbital margin ( you will feel bony touch) Keep nger with pressure this lead to compressing the LA to go to teh formen and prevent it form going to teh orbit whihc lead to transient anetshisa of occlusal muscles Infraorbital nerve block The intraoral approach is as follows: - The patient has the mouth open slightly and the tissues are retracted laterally. - A long (35 mm) needle should be used. infraorbital y a Md Yp Tothere's gas - The needle pierces the height of the buccal sulcus in the mid premolar region. It is advanced superiorly parallel to the premolar t roots until bony contact is made in the region of the infraorbital wnenei.o.namepasses foramen that is being palpated extraorally by the index finger. The needle is then withdrawn slightly to a supraperiosteal position. The general depth of needle penetration is 16 mm (differences) Iiggggggggggigtifiamen - Aspiration is performed and Slowly deposit 0.9 to 1.2 mL (over 30 to 40 seconds). UoS, Dr. Mohammed Amjed Alsaegh, 2023 12 Infraorbital nerve block to b pain dont injectdirectly all UoS, Dr. Mohammed Amjed Alsaegh, 2023 1 2drops wait 10seestheirs 13 Infraorbital nerve block Whatsthe Position ofneedletip Position the needle tip during injection with the bevel facing into the infraorbital foramen and the needle tip touching the roof of the foramen UoS, Dr. Mohammed Amjed Alsaegh, 2023 14 Infraorbital nerve block He will ask possibility of toxicity is with which nerve block? Positive Aspiration 0.7%. - Maintain firm pressure with finger over the injection site both during and for at least 1 minute after the injection (to increase the diffusion of local anesthetic solution into the infraorbital foramen). 7 why recording Q UoS, Dr. Mohammed Amjed Alsaegh, 2023 15 called also UoS, Dr. Mohammed Amjed Alsaegh, 2023 16 Anterior superior alveolar nerve block • AS nerve block is the same as in ltration upper canine but the quantity of anesthesia instead 0.6 we give 1.5 • AS nerve block is a combo of in ltration and nerve block ◦It depends on the In ltration to the bone to anesthetist teh nerve ◦It uses the block because it catches nerve 2023 UoS, Dr. Mohammed Amjedthe Alsaegh, 17 Anterior superior alveolar nerve block pulpof - The anterior superior alveolar nerve supplies the canine and upper incisor teeth. There is some crossover at the midline from the contralateral supply.frominfraorbital nerve - The anterior superior alveolar nerve may be blocked in isolation or by the infraorbital nerve block. d MEFelt by QWhchnitheaeofslogkid - The block of ant sup alv N in isolation is performed by introducing the needle into the buccal sulcus in the maxillary canine regionI and advancing the needle towards the canine apex. The needle is maintained in a supraperiosteal position and following aspiration 1.5 mL of solution is deposited. I 68 UoS, Dr. Mohammed Amjed Alsaegh, 2023 18 Middle superior alveolar nerve block (MSA) • MSA nerve is not always present • For this nerve the technique is similar depends on in lteraiuon but more quantity of LA UoS, Dr. Mohammed Amjed Alsaegh, 2023 19 I Middle superior alveolar nerve block (MSA) - The middle superior alveolar nerve (when present in 28%) provides innervation to the premolar pulps as well as the mesiobuccal pulp of the maxillary first permanent molar tooth. an - When the ASA nerve block fails to provide pulpal anesthesia distal to the maxillary canine, n the MSA block is indicated. D - The success rate of the MSA nerve block is high. Areaofinsertion - Inserting the needle in the buccal sulcus in the second premolar region. Area Target -The needle is advanced to a supraperiosteal position close to the apex of the second premolar tooth and inject 0.9 to 1.2 mL (one half to two thirds cartridge) of solution (approximately 30 to 40 seconds). UoS, Dr. Mohammed Amjed Alsaegh, 2023 20 Middle superior alveolar nerve block (MSA) above b or between 4 5 butin largerquantity Area anesthetized Target area: maxillary bone above the apex of the maxillary second premolar Positive Aspiration is Negligible (<3%). UoS, Dr. Mohammed Amjed Alsaegh, 2023 21 Anterior Middle Superior Alveolar Nerve Block inject • - this is not used why? Because when we inject there will be blanching due to alot of pressure = lead to necrosis • When a patient is anesthetized by this technique it doenst affect the lip so you can evaluate teh smile of teh pateint • Technique is applied between 4 and 5 and mid palatal suture and free gingiva and we inject 0.5 ml UoS, Dr. Mohammed Amjed Alsaegh, 2023 defy 22 Anterior Middle Superior Alveolar Nerve Block registeredit att boot pressure might leadto necrosis - This technique provides pulpal anesthesia of multiple maxillary teeth (incisors, canine, and premolars) - a single injection site on the hard palate about halfway along an imaginary line connecting the midpalatal suture to the free gingival margin. The line is located at the contact point between the first and second premolars - A minimal volume of local anesthetic is necessary - Evaluate the smile line during treatment UoS, Dr. Mohammed Amjed Alsaegh, 2023 23 ityou anesthe thepalate b wont anestheh thelip banesthetize wont themotorofthe lip noparalys canberaluate the smileline UoS, Dr. Mohammed Amjed Alsaegh, 2023 24 Greater palatine nerve block • This block is just for soft tissue UoS, Dr. Mohammed Amjed Alsaegh, 2023 25 T aggeatais Anette Fontaine totes Foster UoS, Dr. Mohammed Amjed Alsaegh, 2023 8 26 Greater palatine nerve block # It is possible to anesthetize the palatal tissues by infiltration or by regional block methods. The greater palatine nerve block anesthetizes the soft tissues of the hard palate o#from third molar to canine region. at #The greater palatine foramen is located palatally to the distal aspect of the upper second molar tooth. The use of a ball-ended instrument such as an amalgam burnisher is useful in locating the site of this foramen. O #The needle is inserted only a few millimeters and aspiration performed. # slowly deposit (30 second minimum). Very little anesthetic solution is required to obtain a greater palatine nerve block. Around 0.2-0.6 mL is sufficient. # Positive Aspiration Less than 1%. very littleamount anesthetize UoS, Dr. Mohammed Amjed Alsaegh, 2023 all the palataltissuetill the 27 canine Greater palatine nerve block Witman distany Initiate Advance the syringe from the opposite side of the mouth at a right angle to the target area UoS, Dr. Mohammed Amjed Alsaegh, 2023 getting 28 • “ I want you to know about palatal block, whoever you give anesthetia distal you will block the inicosive nerve in the anterior block its vice versa its block the posterior UoS, Dr. Mohammed Amjed Alsaegh, 2023 29 Nasopalatine (long sphenopalatine nerve) block UoS, Dr. Mohammed Amjed Alsaegh, 2023 30 Nasopalatine (long sphenopalatine nerve) block # This injection anaesthetizes the soft tissues and bone of the anterior hard palate adjacent to the six anterior teeth. In the canine region some fibers from the greater palatine nerve may provide an accessory supply. # During the injection, the patient has the mouth wide open. The needle is inserted at one side of the incisive papilla. Penetration of only a few millimeters is required; aspiration is performed, and less than 0.2 mL of solution deposited. # Positive aspiration= Less than 1%. 1Etinterdnique # In order to reduce the discomfort of this injection the incisive papilla may be approached via previously anaesthetized buccal tissues by chasing the anesthetic through the central incisor UoS, Dr. Mohammed Amjed Alsaegh, 2023 interdental papilla. 31 Three needle punctures technique? Nasopalatine (long sphenopalatine nerve) block • When you extract teh upper centrals, you give palatal injection give the rst injection as normal a in ltration technique, second injection is giving nasoplatine injection, third is between the two incisors • Q. In which situation for nasoplatine technie? Extraction of multiple incisors UoS, Dr. Mohammed Amjed Alsaegh, 2023 32 Nasopalatine (long sphenopalatine nerve) block Target area: incisive foramen, beneath the incisive papilla UoS, Dr. Mohammed Amjed Alsaegh, 2023 33 Maxillary nerve block • Maxillary nerve block is used when theres an abcess UoS, Dr. Mohammed Amjed Alsaegh, 2023 34 Maxillary nerve block - There are two approaches to the maxillary nerve block – namely, the tuberosity approach and the greater palatine canal approach. - Tuberosity approach is similar to the posterior superior alveolar nerve block, the greater palatine canal approach gains access to the maxillary nerve trunk via the greater palatine canal. - Deposition of local anesthetic solution around the trunk of the maxillary nerve will provide anaesthesia of one-half of the upper jaw, including all of the teeth and the buccal and palatal mucosa. UoS, Dr. Mohammed Amjed Alsaegh, 2023 Major difficulties with the greater palatine canal approach involve locating the canal and negotiating it successfully. The major difficulty in the hightuberosity approach is the higher incidence of hematoma. 35 Tuberosity approach - A long (35 mm) needle must be used. The approach is identical to the posterior superior alveolar nerve block. However, the needle is inserted to a much greater depth – namely, 30 mm. Vs PSA16mm - Orientation of the bevel: toward bone. same area - At this point the needle is in the vicinity of the maxillary nerve within the pterygopalatine fossa. - This end point is superior and medial to the point of injection during the posterior superior alveolar nerve block. Dr. Mohammed Amjed Alsaegh, 2023 36 - Following aspiration, SlowlyUoS,(more than 60 seconds) deposit 1.8 mL UoS, Dr. Mohammed Amjed Alsaegh, 2023 37 Greater palatine canal approach - Target area: the maxillary nerve as it passes through the pterygopalatine fossa; the needle passes through the greater palatine canal to reach the pterygopalatine fossa to contacthehe - The patient has the mouth open wide and the greater palatine foramen is approached from the opposite side. The needle is advanced into the canal superiorly and posteriorly at an angle of 45°. The needle is advanced very slowly along the canal to a depth of 30 mm and slowly deposit 1.8 mL of solution over a minimum of 1 minute. blockyagonemsade ftp.fgcgip.suatca - If bony obstructions are encountered, the needle should not be advanced forcibly. It is better g to withdraw slightly and advance again at a different angle. If an insurmountable barrier is encountered, then this approach should be abandoned. - Bleeding at the needle exit point can occur with this injection. Firm pressure at the site for a few minutes will arrest any hemorrhage. Continue to deposit small volumes of anesthetic throughout the procedure. UoS, Dr. Mohammed Amjed Alsaegh, 2023 38 Approximately 5% to 15% of greater palatine canals have bony obstructions that prevent passage of the needle UoS, Dr. Mohammed Amjed Alsaegh, 2023 39 UoS, Dr. Mohammed Amjed Alsaegh, 2023 40 THE END UoS, Dr. Mohammed Amjed Alsaegh, 2023 41