Head & Neck Ch 9 Pt 1

PSA Block Extraoral Hematoma

This results in a bluish-reddish extraoral swelling of hemorrhaging blood in the tissue within the infratemporal fossa on the affected side of the face a few minutes after the injection, progressing over time inferiorly and anteriorly toward the lower anterior region of the cheek.

Greater Palatine Foramen

Thus this depression can be palpated approximately midway between the median palatine raphe overlying the median palatine suture and the palatal gingival margin of the maxillary molar, starting near to the most distal maxillary molar and moving inward.

IO Block Landmark: Infraorbital Foramen

To locate the infraorbital foramen, extraorally palpate the midpoint of the patient's infraorbital rim and then move slightly inferior approximately 10 mm while applying pressure until the depression created by the infraorbital foramen is felt, surrounded by smoother bone.

Which nerve branches are anesthetized before MOST dental procedures?

Trigeminal nerve

To increase the reliability of local anesthesia procedures, the dental professional MUST learn to rely MAINLY on both visualization and palpation of

hard tissue.

Posterior Superior Alveolar/ PSA Block

in most cases anesthetizes the maxillary molars and associated buccal periodontium and gingiva within one maxillary quadrant if the middle superior alveolar nerve is not present.

Three nerves/divisions of the sensory root of the trigeminal nerve enters the skull

in one of three different locations in the sphenoid bone. 1) The ophthalmic nerve or division enters through the superior orbital fissure. 2) The maxillary nerve or division enters by way of the foramen rotundum. 3) The mandibular nerve or division passes through the skull by way of the foramen ovale.

Which local anesthic block anesthetized the largest intraoral area?

inferior alveolar block

Posterior Superior Alveolar Block needle is inserted

into the height of the maxillary mucobuccal fold in a distal and medial direction superior to the tooth apex without contacting the maxilla in order to reduce trauma, and then the injection is administered.

Two types of local anesthetic injections are used commonly in dentistry:

supraperiosteal infiltration and nerve block.

GP block does not provide anesthesia of the pulp or associated facial periodontal and gingiva of the area teeth

the administration of the ASA, MSA and PSA blocks or the IO block may also be indicated.

Maxillary Nerve

enters by way of the foramen rotundum.

Ophthalmic Nerve

enters through the superior orbital fissure.

The injection site for the greater palatine local anesthetic block is usually located on the palate near which of the following?

Maxillary second or third molar

Paresthesia

Abnormal sensation of burning or prickling from an area.

What SHOULD always be attempted in all injections before administration in order to avoid injection into blood vessels?

Aspiration

If working within the mandibular anterior sextant on the exposed roots of the teeth, which local anesthetic block is MOST clinically effective and comfortable for the patient?

Bilateral incisive block

Which of the following nerves is NOT anesthetized during an inferior alveolar local anesthetic block?

Buccal nerve

What structure can be initially involved in a spread of infection if the needle is contaminated during a posterior superior alveolar block?

Cavernous sinus

Which of the following is an important landmark to locate before administering an inferior alveolar local anesthetic block?

Coronoid notch

In which of the following lcoations is the outcome MOST clinically effective when using a supraperiosteal injection of local anesthetic?

Facial surface of maxillary anterior sextant

Which of the following local anesthetic blocks anesthetizes the associated buccal periodontium and gingiva of the mandibular teeth?

First and second premolars

Which of the following is considered a true mandibular local anesthetic block because it anesthetized the entire mandibular nerve?

Gow-Gate Block

Which of the following local anesthetic blocks uses pressure anesthesia of the tissue to reduce patient discomfort?

Greater Palatine Block

Greater Palatine Block Landmark

Greater Palatine Nerve, greater palatine foramen, and palatine bones

Which of the following injections need to have pressure anesthesia used in order to administer a MORE pain free block?

Greater palatine block

Which of the following local anesthetic blocks is USUALLY associated with self-inflicted trauma?

Inferior alveolar block

Supraperiosteal injection

Injection that anethetizes small area because local anestheic agent is depostied near terminal nerve endings.

Which structures should the dental profession AVOID inadvertently injecting?

Major blood vessels and glandular tissue

Which of the following structures need to be contacted for a successful and safe inferior alveolar block?

Mandibular Bone

PSA Block Landmark

Maxillary Tuberosity, Mucobuccal Fold. and Posterior Superior Alveolar Foramina

Which of the following landmarks should be noted when administering a Gow-Gate local anesthetic block?

Maxillary second molar

PSA Incorrect Needle Angulation: Needle is advanced too deep

May pierce the deeper pterygoid plexus of veins and the maxillary artery if overinserted.

Which of the following local anesthetic blocks has a HIGH risk of positive aspiration?

Mental Block

Which of the following local anesthetic blocks has the SAME injection site as the incisive local anesthetic block?

Mental Block

NP Block Landmark

Nasopalatine Nerve

If an extraction of a permanent maxillary lateral incisor is scheduled, which of the following local anesthetic blocks needs to be administered?

Nasopalatine block

In which of the following locations is the outcome MOST clinically effective when using a supraperiosteal injection of local anesthetic?

Needle tip is located too far anteriorly on the mandibular ramus

Which of these situations can occur if bone is contaced immediately after the needle is inserted into the soft tissue when administering an inferior alveolar local anesthetic block?

Needle tip is located too far anteriorly on the mandibular ramus.

What structure can be punctured if the dental professional does NOT keep the needle in contact with the bone at the roof of the infraorbital foramen to prevent overinsertion when administering an injection in that area?

Orbit

To have complete anesthesia of the maxillary quadrant, which of the following local anesthetic blocks needs to be administered along with the anterior middle superior alveolar local anesthetic block?

Posterior superior alveolar block

Which of the following can serve as a landmark for the anterior middle superior alveolar local anesthetic block?

Premolars

An extraoral hematoma can result from an INCORRECTLY administered posterior superior alveolar local anesthetic block because the needle was overinserted and thus penetrated which of the following?

Pterygoid plexus of veins

Which of the following regions is usually anesthetized during an infraorbital local anesthetic block?

Upper lip, side of nose, and lower eyelid

Which of the following local anesthetic blocks USUALLY anesthetizes the mylohyoid nerve?

Vazirani-Akinosi block

Which of the following are NOT considerations that need to be followed when working with a patient with an oral infection?

Will need less amounts of local anesthetic agent.

Nerve Block

a larger area of anesthesia than a supraperiosteal injection and thus additional teeth. With the nerve block, the local anesthetic agent is deposited near larger nerve trunks. This chapter mainly discusses this type of injection with its more complex anatomic basis.

Pulpal Anesthesia is achieved through

anesthesia of each tooth's dental branches as they extend into the pulp by way of the apical foramen from the superior dental plexus.

Anterior Middle Superior Alveolar/AMSA Block

anesthetizes a large area innervated by the anterior and middle superior alveolar nerves as well as the nasopalatine and greater palatine nerves in the maxillary arch.

Supraperiosteal Injection/Local infiltration

anesthetizes a small area, usually one or two teeth and associated structures, by injection near the apices of the teeth. For this type of local anesthetic injection, the local anesthetic agent is deposited near terminal nerve endings.

Middle Superior Alveolar/MSA Block

anesthetizes maxillary premolars and possibly the mesiobuccal root of the maxillary first molar as well as the associated buccal periodontium and gingiva within one maxillary quadrant if the middle superior alveolar nerve.

Nasopalatine Block

anesthetizes the anterior hard palate and the associated palatal periodontium and gingiva for the maxillary anterior teeth bilaterally from maxillary canine to canine within the maxillary anterior sextant. Both the right and left nasopalatine nerves are anesthetized by this one block.

Anterior Superior Alveolar/ASA block

anesthetizes the anterior superior alveolar nerve and thus anesthetizes the maxillary anterior teeth and associated labial periodontium and gingiva to the midline within one maxillary quadrant.

Greater Palatine/GP Block

anesthetizes the greater palatine nerve and thus anesthetizes the posterior hard palate and the associated palatal periodontium and gingiva of the ipsilateral maxillary posterior teeth within a maxillary posterior sextant.

Infraorbital/IO block

anesthetizes the infraorbital nerve and also both the anterior superior alveolar and middle superior alveolar nerves so as to cover the regions of both the MSA and ASA blocks with one injection.

Anterior Middle Superior Alveolar Block (AMSA Block)

can anesthetize the maxillary anterior teeth and premolars, as well as associated facial periodontium and gingiva of anesthetized teeth to the midline, hard palate, and associated palatal periodontium and gingiva of the ipsilateral maxillary posterior teeth and maxillary anterior teeth bilaterally.

Anterior Middle Superior Alveolar Block is commonly used in

cosmetic dentistry because after the procedures are completed, the clinician can immediately and accurately assess the patient's smile line.

Anterior Middle Superior Alveolar Block (AMSA Block) injection site

is an area on the hard palate superior to the apices of the maxillary premolars and approximately midway between the palatal ginigval margin and the median palatal raphe overlying the median palatine suture. The needle is advanced until the maxilla is gently contacted, and then the injection is administered.

Injection site for IO block

is at the height of the maxillary mucobuccal fold superior to the apex of the maxillary first premolar while keeping pressure with the finger of the other hand on the infraorbital foramen during the injection.

Injection Site for PSA block

is at the height of the maxillary mucobuccal fold superior to the apex of the maxillary second molar, as well as distal to the zygomatic process of the maxilla.

Injection site for the middle superior alveolar block

is at the height of the maxillary mucobuccal fold superior to the apex of the maxillary second premolar without contacting the maxilla

Nasopalatine Block (NP Block) target area

is both the right and left nasopalatine nerves entering the incisive foramen of the maxillae from the mucosa of the anterior hard palate, deep to the incisive papilla, and palatal to the maxillary central incisors. The incisive foramen is located at the midline between the articulating palatine processes of the maxillae.

The target area for the ASA block

is the anterior superior alveolar nerve as part of the superior dental plexus that is superior to the apex of the maxillary canine, just medial to and parallel with the canine eminence without contacting the maxilla.

Target Area for the GP block

is the greater palatine nerve entering the greater palatine foramen from its location between the mucoperiosteum and horizontal plate of palatine bone of the posterior hard palate.

IO block target area

is the infraorbital nerve after entering the infraorbital foramen. Within the infraorbital foramen, the anterior superior alveolar and middle superior alveolar nerves move superiorly to join the infraorbital nerve after it enters.

Crossover-innervation

is the overlap of terminal nerve fibers from the contralateral side of the dental arch.

Posterior Superior Alveolar Block (PSA Block) Target area

is the posterior superior alveolar nerve branches entering the posterior superior alveolar foramina on the infatemporal surface of the maxilla. The posterior superior alveolar foramina are posterosuperior on the maxillary tuberosity as well as superior to the apex of the maxillary second molar.

Transient facial paralysis can occur with which INCORRECTLY administered local anesthetic block?

mental block

If the mesiobuccal root of the maxillary first molar is NOT anesthetized by a posterior superior alveolar local anesthetic block, the dental professional should additionally administer a

middle superior alveolar block

Greater Palatine Block uses pressure anesthesia

over the depression of the greater palatine foramen posterior to the injection site to blanch the tissue throughout the injection will reduce patient discomfort. This pressure anesthesia of the tissue produces a dull ache that blocks pain impulses that arise from the needle insertion and local anesthetic agent deposition.

Injection sit of the GP block is the

palatal tissue anterior to the greater palatine foramen. The needle is advanced until the palatine bone is gently contacted and then the injection is administered.

Nasopalatine Block (NP Block) injection site is the

palatal tissue lateral to the incisive papilla, which is usually located at the midline approximately 10 mm palatal to the maxillary central incisors in case there is no telltale bulge of the structure of the incisive papilla. Needle is advance into the tissue until the maxilla is gently contacted and then the injection is administered.

The skull bones involved in local anesthetic administration by dental professional prior to effective dental care are the maxilla, mandible, and

palatine bones.

Mandibular Nerve and the motor root

passes through the skull by way of the foramen ovale.

The NP block does not anesthetize the pulp or associated facial periodontal and gingiva of the are teeth

so additional anesthesia by the administration of the MSA and ASA block or the IO block may be indicated.

Local anesthesia of the maxillae is more clinically effective than that of the mandible because

the facial cortical plate of the maxillae is less dense and more porous than that of the mandible over similar teeth, and anesthesia from the palatal surface is also possible.

Hard and Soft Tissue of the associated Periodontium and Gingiva are anesthetized by way of

the interdental and interradicular branches for each tooth.

IO block anesthetizes

the maxillary anterior teeth and premolars, as well as the associated facial periodontium and gingiva to the midline within one maxillary quadrant.

Target area of the MSA block is

the middle superior alveolar nerve if present as part of the superior dental plexus that is located superior to the apex of the maxillary second premolar.

The trigeminal or 5th cranial nerve provides

the sensory information for the teeth and associated tissue.

Anterior Middle Superior Alveolar Block target area is

the small pores within the maxilla of the hard palate. As the local anesthetic agent penetrates the pores, it has access from the anterior to middle part of the superior dental plexus, which then anesthetizes the teeth as well as the associated facial and palatal periodontium and gingiva.