Maxillary Anesthesia 4

PALATAL ANESTHESIAPALATAL ANESTHESIA

Greater Palatine Nerve BlockGreater Palatine Nerve Block

Anterior Palatine NerveAnterior Palatine Nerve

Posterior portion of hard palate and Posterior portion of hard palate and overlying soft tissuesoverlying soft tissues

Anteriorly to 1st premolarAnteriorly to 1st premolar

Medially to midlineMedially to midline

Greater Palatine Nerve BlockGreater Palatine Nerve Block

IndicationsIndications

Pain control in posterior palatal hard and/or Pain control in posterior palatal hard and/or soft tissuessoft tissues

ContraindicationsContraindications

Inflammation / infection at injection siteInflammation / infection at injection site

Only small area necessary (eg. 1-2 teeth)Only small area necessary (eg. 1-2 teeth)

Greater Palatine Nerve BlockGreater Palatine Nerve Block

AdvantagesAdvantages

Minimizes penetrations and discomfortMinimizes penetrations and discomfort

Minimizes volume of solution (0.5 ml)Minimizes volume of solution (0.5 ml)

DisadvantagesDisadvantages

Limited hemostasisLimited hemostasis

Potentially traumaticPotentially traumatic

Greater Palatine Nerve BlockGreater Palatine Nerve Block

AlternativesAlternatives

Local infiltration in each areaLocal infiltration in each area

Maxillary Nerve BlockMaxillary Nerve Block

AspirationAspiration

< 1% positive< 1% positive

Greater Palatine Nerve BlockGreater Palatine Nerve Block

LandmarksLandmarks

Greater palatine foramenGreater palatine foramen

Junction of alveolus and palatine boneJunction of alveolus and palatine bone

Area of InsertionArea of Insertion

Soft tissue anterior to foramen, from Soft tissue anterior to foramen, from opposite sideopposite side

Greater Palatine Nerve BlockGreater Palatine Nerve Block

PrecautionsPrecautions

Do notDo not enter canalenter canal

Signs & symptomsSigns & symptoms

Numb posterior palate; painfree treatmentNumb posterior palate; painfree treatment

Safety featuresSafety features

Bone contacted; aspirationBone contacted; aspiration

Greater Palatine Nerve BlockGreater Palatine Nerve Block

TechniqueTechnique

Position - open wide, extend & turn headPosition - open wide, extend & turn head

Cotton swab - identify landmarks, topicalCotton swab - identify landmarks, topical

Approach - bevel to tissue, advance to boneApproach - bevel to tissue, advance to bone

Aspirate; inject 0.5 ml slowlyAspirate; inject 0.5 ml slowly

Greater Palatine Nerve BlockGreater Palatine Nerve Block

FailureFailure

Overlap of fibers from Nasopalatine nerveOverlap of fibers from Nasopalatine nerve

Injection too anteriorInjection too anterior

ComplicationsComplications

Soft tissue ischemia / necrosisSoft tissue ischemia / necrosis

Post injection pain, hematomaPost injection pain, hematoma

NASOPALATINE NERVE BLOCKNASOPALATINE NERVE BLOCK

Nasopalatine Nerve BlockNasopalatine Nerve Block

IndicationsIndications

Pain control in anterior hard and/or soft tissuesPain control in anterior hard and/or soft tissues

ContraindicationsContraindications

Inflammation / infection at injection siteInflammation / infection at injection site

Only small area necessary (eg. 1-2 teeth)Only small area necessary (eg. 1-2 teeth)

Nasopalatine Nerve BlockNasopalatine Nerve Block

AdvantagesAdvantages

Minimizes needle penetrationsMinimizes needle penetrations

Minimizes volume of solution (0.4 ml)Minimizes volume of solution (0.4 ml)

DisadvantagesDisadvantages

Limited hemostasisLimited hemostasis

Potentially traumaticPotentially traumatic

Nasopalatine Nerve BlockNasopalatine Nerve Block

AlternativesAlternatives

Local infiltrationLocal infiltration

Maxillary Nerve BlockMaxillary Nerve Block

AspirationAspiration

< 1% positive< 1% positive

Nasopalatine Nerve BlockNasopalatine Nerve Block

PrecautionsPrecautions

Do not inject directly into papilla/canalDo not inject directly into papilla/canal

Inject slowly, with small volumeInject slowly, with small volume

Signs / symptomsSigns / symptoms

Numb anterior palate; painfree treatmentNumb anterior palate; painfree treatment

Safety featuresSafety features

Bone contacted; aspirationBone contacted; aspiration

Nasopalatine Nerve BlockNasopalatine Nerve Block

TechniqueTechnique

Position - open wide, extend headPosition - open wide, extend head

Landmarks - incisive papilla, central incisorsLandmarks - incisive papilla, central incisors

Approach - lateral to incisive papilla, starting Approach - lateral to incisive papilla, starting with cotton swab, topicalwith cotton swab, topical

Deposit approx. 0.4 ml / 30 sec Deposit approx. 0.4 ml / 30 sec

Nasopalatine Nerve BlockNasopalatine Nerve Block

FailureFailure

May be only unilateralMay be only unilateral

May have overlap with Greater PalatineMay have overlap with Greater Palatine

ComplicationsComplications

Ischemia, tissue necrosisIschemia, tissue necrosis

Others rareOthers rare