MAXILLARY NERVE BLOCKS
POSTERIOR SUPERIOR ALVEOLAR NERVE BLOCK (Zygomatic/ Tuberosity Block)
NERVES ANAESTHETIZED AREAS ANAESTHETIZED INDICATIONS CONTRAINDICATIONS TECHNIQUE LANDMARKS COMPLICATIONS
Posterior Superior Alveolar 1. Pulp of M1,2,3 (Entire 1. Two or more maxillary 1. Risk of haemorrhage – 1. 27-gauge short needle 1. Mucobuccal fold 1. May develop
Nerve tooth anaesthetized – molars Supraperiosteal or PDL recommended 2. Maxillary Tuberosity hematoma
72%, Mesiobuccal root 2. When Supraperiosteal inj is recommended 2. Area of insertion – 3. Zygomatic process of 2. Accidental mandibular
not anaesthetized - injection is Height of Mucobuccal maxilla anaesthesia
28%) contraindicated or fold - above MaxM2
2. Buccal periodontium ineffective 3. Target area – PSA
3. Bone overlining these nerve – Posterior
teeth Superior and Medial
to Posterior border of
maxilla
MIDDLE SUPERIOR ALVEOLAR NERVE BLOCK
NERVES ANAESTHETIZED AREAS ANAESTHETIZED INDICATIONS CONTRAINDICATIONS TECHNIQUE LANDMARKS COMPLICATIONS
1. MSA and terminal 1. Pulp of MaxPM1,2 1. ASA nerve block 1. Infection and 1. 27-gauge short needle 1. Mucobuccal fold 1. Hematoma
branches 2. MB root of M1 failure – To provide Inflammation 2. Area of instertion – above MaxPM2
3. Buccal Periodontal pulpal anaesthesia 2. Where MSA nerve is Height of mucobuccal
Tissue distal to MaxC absent – ASA given fold - above MaxPM2
4. Bone over the same 2. Procedures involving instead 3. Target Area –
teeth MaxPM Max bone above apex
of MaxPM2
ANTERIOR SUPERIOR ALVEOLAR NERVE BLOCK (Infraorbital nerve block)
NERVES ANAESTHETIZED AREAS ANAESTHESIZED INDICATIONS CONTRAINDICATIONS TECHNIQUE LANDMARKS COMPLICATIONS
1. ASA 1. Pulp of MaxCI through 1. More than 2 Max 1. Haemostasis of 1. 25/27-gauge long 1. Mucobuccal fold 1. Hematoma (rare)
2. MSA MaxC teeth localized area needle 2. Infraorbital notch and
3. Infraorbital nerve – 2. 72% - MaxPM and 2. Overlying buccal tissue 2. When only one or two 2. Area of Insertion – Foramen
- Inferior palpebral MBrootM1 3. Inflammation or teeth are involved Height of mucobuccal
- Lateral nasal 3. Buccal Periodontium Infection fold – directly over
- Superior labial and bone of same 4. When Supraperiosteal PM1
teeth injection is ineffective 3. Target area –
4. Lower eyelid, Lateral Infraorbital foramina
aspect of nose, Upper
lip
GREATER PALATINE NERVE BLOCK (Anterior Palatine Nerve Block)
NERVES ANAESTHETIZED AREAS ANAESTHETIZED INDICATIONS CONTRAINDICATIONS TECHNIQUES LANDMARKS COMPLICATIONS
Greater palatine nerve 1. Posterior of hard 1. When palatal soft 1. Inflammation and 1. 27-gauge short needle 1. GP foramen 1. Hematoma (rare)
palate tissue anaesthesia is Infection 2. Area of Insertion – 2. Junction of Max 2. Ischaemia and
2. Anteriorly - PM1 required for 2. Smaller areas Soft tissue anterior to Alveolar process and necrosis
3. Medially - Midline restoration GP foramen palatine bone 3. Patient may be
2. For pain control PD 3. Target areas – uncomfortable
surgery GP nerve passes
anteriorly between
soft tissue and bone
4. Path of insertion –
From opposite side of
mouth @ RT angle to
target area
NASOPALATINE
NERVES ANAESTHETIZED AREAS ANAESTHETIZED INDICATIONS CONTRAINDICATIONS TECHNIQUES LANDMARKS COMPLICATIONS
1. Bilaterally, Nasopalatine 1. Anterior portion of hard 1. Restorative treatment on 1. Inflammation and 1. 27-gauge short needle 1. Central incisor 1. Hematoma (rare)
nerves palate more than 2 teeth Infection 2. Area of insertion – 2. Incisive papilla 2. Necrosis of soft tissues
2. Mesial RT PM1 to Mesial Eg: Subgingival 2. Smaller area of therapy Palatal mucosa lateral to
of LT PM1 restoration, Insertion of incisive papilla
matrix band 3. Target areas –
subgingivally Incisive foramen
2. For pain control during 4. Path of insertion –
PD and Oral surgical 45 degree towards
procedure incisive papilla
