Chapters 10-12 - Quiz 8

What are the divisions of CN5 (Trigeminal) Which are sensory vs motor?

V1 + V2: sensory only

V3: sensory + motor

Where does V2 exit the skull?

foramen rotundum

What are the branches of V2?

1) Nasopalatine nerve

2) Greater palatine nerve

3) PSA nerve

4) Infraorbital nerve > (ASA+MSA nerves)

5) zygomatic nerve

the infraorbital nerve is for which injection nerves

asa & msa

Where does V3 exit the skull?

foramen ovale

What are the major branches of V3

2) Auriculotemporal nerve

3) Muscular branches (to mm)

1) Long buccal nerve

4) Lingual nerve

5) Inferior alveolar nerve

- mylohyoid nerve

- mental nerve

- incisive nerve (NOT palatal)

the inferior avleor nerve gives rise to which nerve

- mylohyoid nerve

- mental nerve

- incisive nerve (NOT palatal)

What does VN3 provide innervation to?

1) motor to muscles of facial expression

2) sensory to anterior 2/3 tongue (taste)

What nerve enters the parotid gland? Does it provide intervention to it?

Facial nerve

- no innervation

What is the function of the pterygoid plexus?

protects the maxillary artery from being compressed during mastication

What is penetrating the pterygoid plexus during PSA associated with?

hematoma + spread of infection

What is the advantage of nerve blocks rather than local anesthesia?

a larger area is anesthitized

What is the purpose of a fulcrum when injecting?

keeps the needle at the target when aspirating

What are the 3 reasons for aspiration?

1) determine if the needle is in a blood vessel

2) prevents intravascular injections

3) prevents toxicity

What are the steps of informed consent?

make patient aware of risks, benefits and consequences of not doing treatment. Document patient's written consent

What is a supraperiosteal injection and when should it be used?

what is known as

used in maxilla for:

- pupal anesthesia of 1-2 teeth more

- soft tissue anesthesia of limited area

commonly know as "local infiltration"

What nerve can be inadvertently anesthetized when giving a PSA?

the inferior alveolar nerve

What is the most common cause of hematoma when giving injections?

entering the pterygoid plexus when giving a PSA block

What precautions can be taken to avoid entering the pterygoid plexus?

4 things

1) use a short needle (27g)

2) use 45° to long axis of the tooth

3) stay close to the bone

4) advance upward, backward & inward

What should you do when you get a positive aspiration on a PSA? How often does this happen?

5 things

1. retract slightly (1-2mm)

2. redirect the needle medially

3. advance the needle 1-2mm and aspirate

4. if negative, advance to proper depth and deliver anesthetic

5. if positive, remove needle SLOWLY and re-evaluate landmarks

occurs 4% of the time

What landmarks are anesthetized with an infraorbital block?

teeth, tissues, skin, and sometimes what

teeth > canine to the midline on L or R

tissues > buccal gingiva with affected teeth

skin > lower eyelid, upper lip and lateral aspect of nose in one quadrant

75% of the time: premolars and part of the first molar as well

What landmarks are anesthetized with an ASA block?

teeth & tissues

teeth: canines and incisors in one quadrant

tissue: labial mucosa and inner aspect of the lip to the midline

What landmarks are anesthetized with an MSA block?

teeth & tissues

teeth: premolars and part of the 1st molar in one quadrant

tissue: buccal gingiva in premolar/1st molar regions

What landmarks are anesthetized with a PSA block?

teeth & tissues

teeth: all molars in one quadrant

tissue: buccal gingiva in molar regions

What landmarks are anesthetized with a nasopalatine block?

teeth & tissues and other name

teeth: none

tissue: palatal soft tissue of anterior hard palate from mesial of 1st premolar to mesial of 1st premolar on other side (whole maxillae)

also called incisive nerve block

What landmarks are anesthetized with a greater palatine block?

what is also called

teeth: none

tissue: palatal soft tissue, from distal canine to hard/soft palate junction, medial to midline in one quadrant

also called anterior palatine nerve block

What landmarks are anesthetized with a buccal block?

tissue

anesthetizes the buccal tissue of the molars

What landmarks are anesthetized with an inferior alveolar block?

teeth

all teeth from the distal of the 3rd molar to the medial of the central incisor in one quadrant and part of the tongue

What landmarks are anesthetized with an incisive block?

teeth

distal of the premolar to the to the medial of the central incisor in one quadrant