Local Anesthesia - Head and Neck

Maxilla has how many primary sites?

4

Palate has how many primary sites?

2

Mandible has how many primary sites?

3

Why are hard structures used as reference points instead of soft tissue?

Soft tissues vary from person to person

Only what nerves are anesthetized?

Sensory

Supraperiosteal injection anesthetizes

Small areas (1 tooth)

Nerve block anesthetizes

Large areas (mult. Teeth)

3 things to know about injections

Site, nerve, adjacent structures

PSA site

2nd molar (height of mucobuccal fold)

PSA sometimes doesn’t anesthetize the

Mesiobuccal root of the maxillary 1st molar

Nerve of the PSA

(PSA branch of the) V2 division of the trigeminal nerve

Adjacent structures of the PSA

Pterygoplexus of veins, PSA artery, parotid gland

MSA site

2nd premolar (height of mucobuccal fold)

Nerve of the MSA

(MSA branch of the) V2 division of the trigeminal nerve

Adjacent structures of the MSA

None

ASA site

Canine (height of mucobuccal fold)

ASA site is what and what

Anterior and parallel to the canine eminence

ASA nerve

(ASA branch of the) V2 division of the trigeminal nerve

Adjacent structures of the ASA injection

None

IO site

1st premolar (height of mucobuccal fold)

IO nerves

ASA and MSA

Adjacent structures of the IO injection

Infraorbital artery

Injections of the palate include…

Greater palatine nerve block, and nasopalatine nerve block

GP Site

Midway between palatine raphe and the lingual gingival margin of the 2nd molar

GP nerve

GP

GP adjacent structures

Lesser palatine nerve

NP Site

Palatal tissues lateral to the incisive papilla

NP nerves

Right and left nasopalatine nerves

Np adjacent structures

Sphenopalatine artery

Injections of the Mandible

IA, Buccal block, mental block, incisive block, Gow gates

IA site

6-10 mm above the occlusal plane on the medial side of the ramus, distal to the retromolar pad

Lingual site

Anesthesia deposited when the needle is pulled out halfway of the IA nerve block

IA nerves

IA and lingual branches of the V3 of the trigeminal nerve

Adjacent structures of the IA nerve block

Parotid gland, IA artery, lingual nerves

Buccal site

Buccal mucosa distobuccal to the most distal of the mandibular molar

Buccal block nerve

Buccal nerve of the V3 trigeminal nerve

Adjacent structures of the buccal block

None

Mental site

Mucobuccal fold tissues over the depression created by the mental Foramen

Adjacent structures of the mental injection

Mental artery

Incisive site

Same as mental, except to massage the area after injection

Adjacent structures of the incisive injection

Mental artery

Gow gates site

Oral mucosa on the medial side of the ramus distal to the Mesiolingual cusp of the max 2nd molar

Adjacent structures of the Gow gates

Max artery and lingual nerve branches