LOCAL ANAESTHESIA:ANATOMICAL LANDMARKS
SEMINAR 1DR.LEENA PARMAR
CONTENTS:
1. INTRODUCTION2. TRIGEMINAL NERVE a.Ophthalmic division b.Maxillary division c.Mandibular division3.Osteology of maxilla and mandible4.Anatomical landmarks in various
injection techniques
INTRODUCTION
Understanding 0f the management of pain in dentistry requires thorough knowledge of nerves and bones a dentist has to deal with.
Mainly the Trigeminal nerve and its three divisions , maxilla and mandible.
TRIGEMINAL NERVE
Largest cranial nerve Ganglion associated with trigeminal
nerve is semi-lunar or gasserian ganglion which is located in Meckle’s cavity of temporal bone.
Functions- MotorSensory-general & gustatory
Petrous part of temporal bone
Motor root : supplies the following muscles
1. Masticatory-masseter,temporalis,pterygoideus medialis and pterygoideus lateralis
2. Mylohyoid3. Anterior belly of digastric muscle4. Tensor tympani5. Tensor veli palatini
Sensory Root
Comprises the central part of semilunar ganglion.
3 divisions- o Ophthalmic division(v1)o Maxillary division(v2)o Mandibular division(v3)
Ophthalmic Division
Smallest of three divisions Exclusively sensory Leaves cranium from superior orbital fissure Supplies-eyeballs,conjunctiva,lacrimal gland, Parts of mucous membrane of nose and para-
nasal sinus,skin of forehead,eyelids and nose. 3 divisions- Nasociliary nerve Frontal nerve Lacrimal nerve
Maxillary Nerve Leaves cranium from foramen
rotundum
1.Branches in cranium-middle meningeal nerve
2.Branches in pterygo-palatine fossa;a) Zygomatic nerve-
Zygomatico-temporal nerve Zygomatico-facial nerve
b.Pterygopalatine nerves-Orbital branchesNasal branch and naso-palatine
nervePalatine branchGreater(anterior palatine nerve i,.lesser(middle or
posterior )palatine nerve ii.pharyngeal branchesc)Posterior superior alveolar nerve
3.branches within the infra orbital canal
a)middle superior alveolar nerve b)anterior superior alveolar nerve4.Branches on face a)inferior palpebral branch b)external nasal branch c)superior labial branch
Maxillary Nerve innervates;
1.Skin-a) Middle portion of faceb) Lower eyelidc) Side of the nosed) Upper lip
2.Mucous membrane- e) Naso-pharynxf) Maxillary sinusg) Soft palateh) Tonsili) Hard palate
3.Maxillary teeth and periodontal tissues
NOTE-NASOPALATINE NERVE
Terminal branch enters incisive canal and
comes out from incisive foramen
Provides sensation to palatal mucosa in the reason of pre maxilla(Central incisors,lateral incisors and canines)
Present 1 cm posterior to maxillary central incisor
Mandibular Nerve
Largest division
Leaves the cranium from foramen ovale
Has large sensory root and small motor root
Branches of Mandibular nerve
1. Branches from the undivided nerve- a)nervous spinosus
b)nerve to medial pterygoid
muscle
2.Branches from anterior division a) Nerve to lateral pterygoidb) Nerve to the masseter c) Nerve to the temporalisd) Buccal nerve
3.branches from the posterior division a)aurico-temporal nerve b)lingual nerve c)mylohyoid nerve d)inferior alveolar nerve e)mental branch f)incisive branch
.
Nerve innervation around condylar process of mandible
Special note 1: buccal nerve Also known as long buccal
nerve/buccinator nerve
Emerges under the anterior border of masseter muscle
Provides sensory innervation to 3rd ,2nd & 1st mandibular molar,mucobuccal fold of this region,sensory innervation to cheek
Special note 2:lingual nerve Runs parallel to inferior alveolar
nerve(medially) and also medial to submandibular salivary gland duct
Provides sensory innervation to anterior 2/3 of tongue(normal sensory and special sensory along with chorda-tympani fibers),mucous membrane of floor of the mouth and gingiva of the lingual side of mandible
Special note 3:inferior alveolar nerve
It runs parallel and lateral to lingual nerve on the medial surface of the mandible
Enters mandible at mandibular canal level
Emerges from the mental foramen
Gives off dental branch-incisive branches
MAXILLA
Anterior view of maxilla
SENSORY INNERVATION OF PALATE
MANDIBLE
Lateral view of mandible
Posterior view of mandible
REFERENCES
1. Handbook of LOCAL ANAESTHESIA-Stanley F Malamed
2. Atlas of anatomy-Anne M Gilroy3. GRANT’S atlas of anatomy-Anne
M.R.A agur & Arthur F Dalley
Summary of maxillary injection
Supra peri-osteal injection
Posterior-superior alveolar nerve
Middle-superior alveolar nerve
Anterior superior alveolar nerve
Infra-orbital(IO) nerve
Greater palatine(GP) nerve block
Nasopaltine(NP) nerve block
anterior middle superior alveolar(AMSA) nerve block
summary of mandibular injections
Inferior Alveolar Nerve Block
Buccal Nerve Block
Mental Nerve Block
Incisive Nerve Block
Gow-Gates Mandibular block
Periodontal Ligament Injection
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