clinical landmarks relevant to nerve anaesthesia and mandibular pathway of innervation to oral tissues

Identify clinical landmarks relevant to maxillary nerve anaesthesia;

I’m unsure how much detail to go into for these because in the lecture slide it really only talks about nasopalatine, greater and lesser palatine nerve, but in the book it goes into PSA, ASA and MSA..?

Greater Palatine;

- used when palatal soft tissue anaesthesia is required for two or more maxillary posterior teeth

- does not provide pulpal anaesthesia- using ASA, PSA, MSA is also required

- injection site; anterior to the greater palatine foramen, which is at the junction of the maxillary alveolar process and the hard palate, at the apex of the maxillary second or third molar

Nasopalatine;

- portion of the hard palate from the mesial of right maxillary first premolar to the mesial of the left maxillary first premolar

- used when palatal soft tissue anaesthesia is required for two or more maxillary anterior teeth

- injection site; NP nerves located at the incisive foramen on the anterior hard palate of the maxilla, lingual to the maxillary central incisors (beneath the incisive papailla)

Lesser Palatine;

- the book doesn’t mention it…

- just the lesser palatine foramen? :S posterior to maxillary third molars..?

Identify clinical landmarks relevant to mandibular nerve anaethesia;

Once again, I think the inferior alveolar is the main one to know, but the book also talks about mental, incisive etc.

Inferior Alveolar;

- this procedure attempts to anaesthetise the inferior alveolar nerve prior to it entering the mandibular foramen

- administration of anaesthesia near the mandibular foramen causes blockage of the inferior alveolar nerve and the nearby lingual nerve (supplying the tongue)

- IAN; anaesthetises the lower lip and the teeth and gingivae of the mandible

- injection site; superior to the entry point of the IA nerve into the mandibular foramen

- determined by palpating the coronoid notch

- parallel to the coronoid notch and 6-10mm superior to the occlusal plane of the mandibular molar teeth

- if needle is positioned too posteriorly, anaesthetic may be put into parotid gland, resulting in Bells Palsy-like symptoms

Buccal;

- used for buccal periodontium of the mandibular molars including the gingival, PL, alveolar bone

- injection site; buccal tissues distal and buccal to the most distal molar tooth

Describe the neuroanatomical pathways of the innervation of the mandibular oral tissues

- motor and sensory roots exit through the forman ovale and then combine

- divide into anterior and posterior trunks in the infratemporal fossa

- anterior division; masseteric nerve, deep temporal nerve, buccal nerve, lateral pterygoid nerve

- posterior division; lingual nerve, IAN (mylohyoid nerve, mental nerve, incisive nerver)

- before the IAN goes through mandibular foramen, it gives off the nerve to the mylohyoid

- enters the mandible via the mandibular foramen

- while in the mandibular canal within the mandible, gives off the mental nerve, which exits via the mental foramen

- IAN continues as the incisive nerve; innervates man canines/incisors

any feedback would be amazing! thanks (: