Middle Superior Alveolar Nerve Block

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Middle Superior Alveolar Nerve Block

• Nerve Anesthetized
• Middle Superior Alveolar Nerve
• - Maxillary premolars and buccal tissues

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Areas Anesthetized

• Pulpal anesthesia of first second premolars and
  mesiobuccal root of first molar
• Buccal soft tissues and bone over same teeth

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Indications

• Anesthesia of maxillary premolars only
• Infraorbital nerve block failure

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Contraindications

• Infection /inflammation in area of injection

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Advantage

• Minimized number of injections
• Minimized volume of solution

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Disadvantage

• MSA nerve is only present 28 of the time

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Alternatives

• Local infiltration (supraperiosteal)
• Periodontal ligament injection (PDL)
• Infraorbital nerve block

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Landmarks / Area of Insertion

• Mucobuccal fold above second premolar
• Apex of second premolar

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Signs and Symptoms

• Numb upper lip
• Pain free dental therapy

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Safety Features

• Anatomically safe (no signifcant structures)
• Relatively avascular area
• positive aspirations - negligible (lt 3)
• Complications are rare

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Technique - MSA

• Apply topical
• Position patient and identify landmarks
• Insert needle 5-10 mm
• Aspirate
• Inject 0.9 ml of solution, slowly

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Failures of Anesthesia

• Needle inserted too high, or not high enough
• Deposition of solution too far laterally

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Infraorbital Nerve Block
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Nerves Anesthetized

• Anterior Superior Alveolar Nerve
• Middle Superior Alveolar Nerve
• Superior Labial Nerve
• also
• Inferior Palpebral Nerve
• Lateral Nasal Nerve

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Areas Anesthetized

• Pulpal anesthesia of maxillary anterior teeth
• Pulpal anesthesia of premolars and mesiobuccal
  root of first molar
• Buccal soft tissue and bone of same teeth
• Lower eyelid, lateral nose, and upper lip

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Indications

• Anesthesia of more than two maxillary teeth
• Supraperiosteal injections ineffective
• Inflammation/infection contraindicating local
  infiltration

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Contraindications

• Discrete treatment areas (1-2 teeth only)
• Hemostasis
• Bleeding problems (eg. hemophelia, etc..)

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Landmarks

• Mucobuccal fold above first premolar
• Infraorbital notch
• Infraorbital foramen

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Area of Insertion

• Mucobuccal fold above first premolar
• Target area
• Infraorbital foramen
• Neurovascular bundle

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Advantages

• Comparatively simple, safe technique
• Minimized volume of solution
• Minimized number of needle punctures

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Disadvantages

• Psychological
• Administrator- fear of eye involvement
• Patient- apprehension of extraoral approach
• Anatomical
• Difficulty defining landmarks

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Alternatives

• Supraperiosteal injection for each tooth
• Maxillary nerve block

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Signs and Symptoms

• Tingling and numbness of lower eyelid, side of
  nose, and upper lip
• Numbness in teeth and soft tissues
• No pain during dental therapy

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Safety Features

• Needle contacting bone
• Finger over infraorbital foramen

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Technique

• Apply topical
• Position patient and identify landmarks
• Insert needle to upper rim of infraorbital
  foramen
• Aspirate
• Inject 0.9 ml of solution, slowly

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Failures of Anesthesia

• Bone contact below infraorbital foramen
• Needle deviates laterally or medially

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Complications

• Hematoma (rare)
• Positive aspirations - 0.7