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maxillary local anesthesia

Terms in this set (57)

what are the 5 branches of the maxillary (V2)
-PSA
-infraorbital
-greater palatine
-lesser palatine
-nasopalatine
what are the 2 branches of the infraorbital
-middle superior alveolar
-anterior superior alveolar
what are the 3 branches of the mandibular (v3) branch
-inferior alveolar
-lingual
-long buccal
what are the 3 branches of the inferior alveolar
-mylohyoid
-mental
-incisive
if you want to anesthesize the teeth and buccal hard and soft tissue, what injection should you use?
-anterior superior nerve block
-middle superior alveolar nerve block
-posterior superior alevolar nerve block
-supraperior injection (infiltration)
what 2 injections are we giving
-supraperiosteal injection (infiltration)
-palatal infiltration technique
what is the most common maxillary injection technique
the supraperiosteal injection
what is the supraperiosteal injection ideally suited for
-single tooth or small circumscribed portion of the maxilla
where is the anesthetic solution placed
-adjacent to the periosteum of the alveolar bone overly the apex of the tooth
the maxilla is relatively porous and has a _____ cortical plate
thin
what are the cross hairs for a suprapeirosteal injection?
-height of mucobuccal fold
-long axis of tooth
---tooth length
---zygomatic process
describe the height of the mucobuccal fold
-the line of flexure of the oral mucous membrane as it passes from the maxilla to the cheek
for maxium effect, where should the needle tip be located
overlie the apex of the tooth being anesthesized

-inserted under the mucosa so that it lies adjacent to the bone WITHOUT impinging on the richly innervated periosteum
what is the periosteum
-dense fibrous membrane covering the surface of bones except at the joints and serving as an attachment for muscles and tendons
what is the length of the cent ins, lat ins, canine, 1st pre, 2nd pre, 1st molar, 2nd molar?
cent ins: 12.4
lat ins: 13.5
canine: 17.0
1st pre: 13.8
2nd pre: 13.0
1st m: 12.8
2nd m: 12.0
what should you do if bone is contacted during a maxillary infiltration?
-needle is withdrawn slightly to avoid injection under the periosteum
what is the appropriate needle gauge and length for a maxillary infiltration?
25 or 27 gauge short
what is the appropriate operator position
8 or 9 o'clock
what tooth do you need to take the zygomatic process into consideration?
maxillary first molar
why do you need to take the zygomatic process into consideration?
An infiltration directly over the roots of the maxillary first molar may be ineffective due to the bulk and density of the overlying zygomatic process which may prevent adequate penetration of the anesthetic
how should you give a first molar injection?
-anesthesize by 2 injections
--one over the apex of the 2nd pre
--one over the roots of the 2nd molar
The area of anesthesia for a single-tooth supraperiosteal injection includes the _____ and _____ tissues adjacent to the tooth
pulp
labial/buccal
how should you gauge the depth of anesthesia?
explorer or just beginning treatment
where does the ASA usually divide
maxillary bone
if you want to give an ASA nerve block, where do you inject?
anterior to canine eminence
if you want to give an infraorbital nerve block
over first premolar
where do you deposit the anesthesia for an infraorbital nerve black?
infraorbital foramen
what nerves are anesthesized if you give an infraorbital nerve block?
ASA, MSA, IO
what is the needle gauge and length for an ASA field block injection?
25 or 27 short
what are the cross hairs for an ASA injection?
-height of mucobuccal fold
-canine fossa
how much do you inject for a ASA injection?
1/2 cartridge
what % of people dont have the MSA nerve
60-70%
what is the needle gauge and length for an MSA
25 or 27 gauge short
what are the cross hairs for the MSA injection
-height of the mucobuccal fold
-adjacent to the second premolar
how much do you inject for an MSA
1/2 to 2/3 of cartridge
Anesthesia of the maxillary molar region is most readily accomplished by a block injection of the _____
posterior superior alveolar nerve
what is the major anatomic landmark for a PSA nerve blocl?
zygomatic process
-lies in front of the target area
-easily palpated buccal to the first molar
where is the site of deposition for a PSA nerve block
-posteriolateral aspect of the maxilla
-about 1 cm above
-behind the apices of the last molar
what is the needle gauge and length for a PSA nerve block
25 gauge short
how should the patients mouth be positioned for a PSA nerve block
-nearly closed
-mandible shifted toward the side to be injected
(this relaxes the cheek and moves the coronoid process of the ascending ramus of the mandible away from the maxillary tuberosity)
where should you palpate for a PSA nerve block?
distal boundary of the zygomatic process
what are the cross hairs for the PSA nerve blocj?
-height of mucobuccal fold
-immediately posteriro to the zygomatic process
-superior to the distobuccal root of the maxillary 2nd molar
what is the shape of the maxilla in the area for a PSA nerve block?
convex, limits access
how should you insert the needle?
at a 45* angle to the patients occlusal and midsaggital planes

- short needle must be direct upward, inward, and backward about 1.5cm
how many times do you need to aspirate for a PSA?
3x
how much do you deposit for a pSA?
1/2 to 1 cartridge
what are the 3 main complication that may happen with a PSA?
-bone may be encountered prematurely (too anterior)
-cheek puncture can occur if proper positioning is not adhered to
-HEMATOMA can occur if penetration of the pterygoid venus plexus occurs (too posterior)
what does a palatal infiltration often accompany
buccal infiltration
what do you use as a "pain distraction" for needle insertion into the palatal tissue
cotton application
where do you inject for a palatal infiltration?
5-10mm from gingival margin
how should the needle be inserted for a palatal infiltration?
45*
inserted about 3mm until bone is gently contacted
where is the greater palatine foramen?
lateral to the second or third molar
what are the landmarks for a greater palatine nerve block?
-greater palatine foramen
-junction of the maxillary alveolar process and palatine bone
what is the proper needle guage and length for a greater palatine nerve block
27 or 30 gauge short
how should the patients mouth be opened for a greater palatine nerve block?
-opened wide with head tilted up
-cotton swab at the landmarks until the swab falls into the depression created by the greater palatine foramen
where is the incisive foramen located?
-midway between the canines
-about 5mm behind the lingual border of the central incisors
where do you need to inject to anesthesize an entire maxillary quadrant?
1. between molars
2. between premolars
3. mesial aspect of canine
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