PALATAL ANESTHESIA

Greater Palatine Nerve Block Anterior Palatine Nerve Posterior portion of hard palate and overlying soft tissues Anteriorly to 1st premolar Medially to midline

Greater Palatine Nerve Block Indications Pain control in posterior palatal hard and/or soft tissues Contraindications Inflammation / infection at injection site Only small area necessary (eg. 1-2 teeth)

Greater Palatine Nerve Block Advantages Minimizes penetrations and discomfort Minimizes volume of solution (0.5 ml) Disadvantages Limited hemostasis Potentially traumatic

Greater Palatine Nerve Block Alternatives Local infiltration in each area Maxillary Nerve Block Aspiration < 1% positive

Greater Palatine Nerve Block Landmarks Greater palatine foramen Junction of alveolus and palatine bone Area of Insertion Soft tissue anterior to foramen, from opposite side

Greater Palatine Nerve Block Precautions Do not enter canal Signs & symptoms Numb posterior palate; painfree treatment Safety features Bone contacted; aspiration

Greater Palatine Nerve Block Technique Position - open wide, extend & turn head Cotton swab - identify landmarks, topical Approach - bevel to tissue, advance to bone Aspirate; inject 0.5 ml slowly

Greater Palatine Nerve Block Failure Overlap of fibers from Nasopalatine nerve Injection too anterior Complications Soft tissue ischemia / necrosis Post injection pain, hematoma

NASOPALATINE NERVE BLOCK

Nasopalatine Nerve Block Indications Pain control in anterior hard and/or soft tissues Contraindications Inflammation / infection at injection site Only small area necessary (eg. 1-2 teeth)

Nasopalatine Nerve Block Advantages Minimizes needle penetrations Minimizes volume of solution (0.4 ml) Disadvantages Limited hemostasis Potentially traumatic

Nasopalatine Nerve Block Alternatives Local infiltration Maxillary Nerve Block Aspiration < 1% positive

Nasopalatine Nerve Block Precautions Do not inject directly into papilla/canal Inject slowly, with small volume Signs / symptoms Numb anterior palate; painfree treatment Safety features Bone contacted; aspiration

Nasopalatine Nerve Block Technique Position - open wide, extend head Landmarks - incisive papilla, central incisors Approach - lateral to incisive papilla, starting with cotton swab, topical Deposit approx. 0.4 ml / 30 sec

Nasopalatine Nerve Block Failure May be only unilateral May have overlap with Greater Palatine Complications Ischemia, tissue necrosis Others rare