6. Anatomy & Techniques for Maxillary Injections Flashcards
(14 cards)
INJECTIONS OF THE MAXILLA \_\_\_\_)! \_\_\_\_ block! \_\_\_\_nerve block! \_\_\_\_ canal block (nasopalatine & greater palatine nerve)
PSA
infraorbital
greater palatine
incisive
EXTRAORAL INJECTIONS
____ nerve block!
____ injections!
____ point injections
auriculotemporal
TMJ
trigger point
MAXILLARY NERVE
Purely ____ nerve!
Exits ____!
Maxillary nerve: ____ palatine, nasopalatine, ____ nasal nerve, zygomatic nerve, posterior superior alveolar nerve, ____ nerve, anterior/middle alveolar nerves
sensory foramen rotundum greater posterior infraorbital
MAXILLARY NERVE
Greater palatine nerve: ____ mucous membrane of hard and gingiva of the ____. !
Infraorbital nerve: ____, lateral skin of nose, mucous membrane of ____, skin and mucous membrane of ____!
Superior dental plexus: Formed from the ____, middle and anterior superior alveolar branches. Innervate ____ and ____ gingiva
posterior
hard palate
lower eyelid
nose
upper lip
psoterior
teeth
bucal
INFRAOBITAL NERVE BLOCK
Infraorbital nerve: lower ____, lateral skin of nose, mucous membrane of ____, skin and mucous membrane of ____ and ____ teeth/periodontium
eyelid
nose
upper lip
anterior
PSA complications
showing ____ - this is what can cause swelling/bruising w/ injection
pterygoid plexus
Greater palatine injection
• for the palate: start w/ blocks, then go to infiltrations!
• don’t just do infiltration! will hurt very very bad - only hard tissue on palate around tooth so he strongly suggests using a block although some ppl will advise not to (it’s a personal preference he suggests)
• The advantage for the greater palatine is that you can palpate it on yourself + patient
◦ The technique he likes: take end of mirror + put ____ on nerve to lessen pain slightly, just like how when your foot falls asleep
◦ if anesthesia is incomplete or if you need vasoconstriction, THEN do ____
‣ give it 2-5 min first before doing the local
◦ just emphasizing blocks first + how locals hurt (soft/hard tissue)
pressure
local
INCISIVE CANAL BLOCK ! (NASOPALATINE & GREATER PALATINE NERVE)
____ gingiva of ____
anterior
hard palate
TRIGGER POINT INJECTIONS
• other mid-face injections we may be doing
• transcutaneous injections
◦ trigger point is for ____ disorder that’s primarily ____ in nature
◦ can inject medication or do dry annealing (?? I couldn’t understand if this is what he said but either way
he’s rambling) the muscles of mastication or the ____’ insertion points, which can be causing a patient pain
◦ small ____ needle - one concern is ____ nerve through parotid gland - key to avoiding nerve while still hitting masseter is to inject down to bone
◦ very ____ bolus - 1/10 of cc into masseter insertion + temporals insertion through skin
◦ take one index finer to mouth + thumb to skin + bimanually palpate that area - can do this on yourself @
home: when you clinch, you can really feel the tendon of the masseter
TMD
myofacial
TMJ
small
TMJ INJECTION
____ innervation!
- ____ n.!
- ____ n.!
- ____ n.!
sensory
auriculotemporal
deep temporals
masseter
AURICULOTEMPORAL NERVE BLOCK
____ nerve
____ nerve
• TMJ block through auriculotemporal nerve
◦ this nerve starts medially, wraps around neck of condyle
◦ what you’ll do is prep skin w/ B9 or some type of skin prep -> palpate the neck of the ____
◦ image A: inject right down to bone -> give small bolus -> gets ear, joint
◦ don’t do large bolus b.c a little lower is branch of facial nerve
‣ same risk as trigger point injections you can get facial ____
trigeminal
facial
condyle
paresthesia
TMJ ANATOMY
• intra-airticular injection : steroid injection, ____ block
◦ when evaluating the TMJ for pain, it can be very difficult differentiating pain intra-articular joint pain + myofascial pain, this is b.c ____ + tendons running over top of ____
◦ most people have a ____ of primary muscle + secondarily joint pain or vice a versa
◦ So when you’re palpating, you’re feeling the muscles + the joint, but you can’t differentiate what is actually causing the pain. So what we do is a ____ injection helps identify this
‣ goes to next slide
diagnostic muscles joint combo diagnostic
TMJ INJECTION
• put thumb right in front of ear on root of zygomatic arch - have patient open/close - the depression is the joint
◦ have needle pass through ____ - aim superiorly to hit the arch so we know where our needle is
-> walk it down to pass through the joint -> as it passes through the joint, it’s still directed
superiorly so it should hit the medial point of ____ and that’s how you know you’re in joint
• 2nd way to confirm that you’re in the joint is you should have some ____
◦ small, enclosed space so getting resistance
• if you don’t get 2nd hit of bone - you could’ve pass through the capsule or be too far in front of or behind the
joint
◦ if you’re freely injecting you’re not in the joint
• inject 1⁄2 cc + see how much pain relief patient gets - never 100%
◦ if it’s 70% relief, you know it’s 70% joint pain vs myofascial
• other technique:
◦ 2 needles one w/ fluid going in + 1 going out - they need to equal each other; if NOT then it could be going:
‣ going laterally: parotid capsule -> swelling but will resorb briefly
‣ medially: pharyngeal spaces around airway -> more of a concern w/ swelling of airway
◦ drawing line: from tragus to lateral canthus
‣ don’t need to know this!
joint
glenoid fossa
resistance
COMPLICATIONS
____! Trismus!
____ nerve palsy! Nerve injury! Infection!
Pain
- whole lecture on complications
- Hematoma/bruising w/ PSA
- trismus injury to masseter or mesial pterygoid
- palsy: ____ injection, trigger point injections
- nerve injury: close, but not into joint we inject - clues are that patient might report stinging sensation
- infection - needle becomes unsterile when you inject into abscess
hematoma
facial
TMJ
