The Incisive Canal: a Comprehensive Review. Cureus 10(7): E3069
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Palatal Injection Does Not Block the Superior Alveolar Nerve Trunks: Correcting an Error Regarding the Innervation of the Maxillary Teeth
Open Access Review Article DOI: 10.7759/cureus.2120 Palatal Injection does not Block the Superior Alveolar Nerve Trunks: Correcting an Error Regarding the Innervation of the Maxillary Teeth Joe Iwanaga 1 , R. Shane Tubbs 2 1. Seattle Science Foundation 2. Neurosurgery, Seattle Science Foundation Corresponding author: Joe Iwanaga, [email protected] Abstract The superior alveolar nerves course lateral to the maxillary sinus and the greater palatine nerve travels through the hard palate. This difficult three-dimensional anatomy has led some dentists and oral surgeons to a critical misunderstanding in developing the anterior and middle superior alveolar (AMSA) nerve block and the palatal approach anterior superior alveolar (P-ASA) nerve block. In this review, the anatomy of the posterior, middle and anterior superior alveolar nerves, greater palatine nerve, and nasopalatine nerve are revisited in order to clarify the anatomy of these blocks so that the perpetuated anatomical misunderstanding is rectified. We conclude that the AMSA and P-ASA nerve blockades, as currently described, are not based on accurate anatomy. Categories: Anesthesiology, Medical Education, Other Keywords: anatomy, innervation, local anesthesia, maxillary nerve, nerve block, tooth Introduction And Background Anesthetic blockade of the posterior superior alveolar (PSA) branch of the maxillary nerve has played an important role in the endodontic treatment of irreversible acute pulpitis of the upper molar teeth except for the mesiobuccal root of the first molar tooth [1, 2]. This procedure requires precise anatomical knowledge of the pterygopalatine fossa and related structures in order to avoid unnecessary complications and to make the blockade most effective. The infraorbital nerve gives rise to middle superior alveolar (MSA) and anterior superior alveolar (ASA) branches. -
Anatomy of Maxillary and Mandibular Local Anesthesia
Anatomy of Mandibular and Maxillary Local Anesthesia Patricia L. Blanton, Ph.D., D.D.S. Professor Emeritus, Department of Anatomy, Baylor College of Dentistry – TAMUS and Private Practice in Periodontics Dallas, Texas Anatomy of Mandibular and Maxillary Local Anesthesia I. Introduction A. The anatomical basis of local anesthesia 1. Infiltration anesthesia 2. Block or trunk anesthesia II. Review of the Trigeminal Nerve (Cranial n. V) – the major sensory nerve of the head A. Ophthalmic Division 1. Course a. Superior orbital fissure – root of orbit – supraorbital foramen 2. Branches – sensory B. Maxillary Division 1. Course a. Foramen rotundum – pterygopalatine fossa – inferior orbital fissure – floor of orbit – infraorbital 2. Branches - sensory a. Zygomatic nerve b. Pterygopalatine nerves [nasal (nasopalatine), orbital, palatal (greater and lesser palatine), pharyngeal] c. Posterior superior alveolar nerves d. Infraorbital nerve (middle superior alveolar nerve, anterior superior nerve) C. Mandibular Division 1. Course a. Foramen ovale – infratemporal fossa – mandibular foramen, Canal -> mental foramen 2. Branches a. Sensory (1) Long buccal nerve (2) Lingual nerve (3) Inferior alveolar nerve -> mental nerve (4) Auriculotemporal nerve b. Motor (1) Pterygoid nerves (2) Temporal nerves (3) Masseteric nerves (4) Nerve to tensor tympani (5) Nerve to tensor veli palatine (6) Nerve to mylohyoid (7) Nerve to anterior belly of digastric c. Both motor and sensory (1) Mylohyoid nerve III. Usual Routes of innervation A. Maxilla 1. Teeth a. Molars – Posterior superior alveolar nerve b. Premolars – Middle superior alveolar nerve c. Incisors and cuspids – Anterior superior alveolar nerve 2. Gingiva a. Facial/buccal – Superior alveolar nerves b. Palatal – Anterior – Nasopalatine nerve; Posterior – Greater palatine nerves B. -
Comparison of Greater Palatine Nerve Block with Intravenous Fentanyl for Postoperative Analgesia Following Palatoplasty in Children
Jemds.com Original Research Article Comparison of Greater Palatine Nerve Block with Intravenous Fentanyl for Postoperative Analgesia Following Palatoplasty in Children Amol Singam1, Saranya Rallabhandi2, Tapan Dhumey3 1Department of Anaesthesiology, JNMC, DMIMS, Sawangi Meghe, Wardha Maharashtra, India. 2Department of Anaesthesiology, JNMC, DMIMS, Sawangi Meghe, Wardha, Maharashtra, India. 3Department of Anaesthesiology, JNMC, DMIMS, Sawangi Meghe, Wardha, Maharashtra, India. ABSTRACT BACKGROUND Good pain relief after palatoplasty is important as inadequate analgesia with vigorous Corresponding Author: cry leads to wound dehiscence, removal of sutures and extra nursing care. Decrease Dr. Saranya Rallabhandi, in oxygen requirement and cardio-respiratory demand occur with good pain relief Assisstant Professor, and also promotes early recovery. Preoperative opioids have concerns like sedation, Department of Anesthesiology, AVBRH, DMIMS (DU), Sawangi Meghe, respiratory depression and airway compromise. Greater palatine nerve block with Wardha- 442001, Maharashtra, India. bupivacaine is safe and effective without the risk of respiratory depression. The study E-mail: [email protected] was done to compare pain relief postoperatively with intravenous fentanyl and greater palatine nerve block in children following palatoplasty. DOI: 10.14260/jemds/2020/549 METHODS How to Cite This Article: 80 children of ASA I & II, between 1 to 7 years were included and allocated into two Singam A, Rallabhandi S, Dhumey T. Comparison of greater palatine nerve block groups of 40 each. Analgesic medication was given preoperatively after induction of with intravenous fentanyl for postoperative general anaesthesia, children in Group B received greater palatine nerve block with analgesia following palatoplasty in -1 2 mL 0.25% inj. Bupivacaine (1 mL on each side) and Group F received 2 μg Kg I.V. -
A Review of the Mandibular and Maxillary Nerve Supplies and Their Clinical Relevance
AOB-2674; No. of Pages 12 a r c h i v e s o f o r a l b i o l o g y x x x ( 2 0 1 1 ) x x x – x x x Available online at www.sciencedirect.com journal homepage: http://www.elsevier.com/locate/aob Review A review of the mandibular and maxillary nerve supplies and their clinical relevance L.F. Rodella *, B. Buffoli, M. Labanca, R. Rezzani Division of Human Anatomy, Department of Biomedical Sciences and Biotechnologies, University of Brescia, V.le Europa 11, 25123 Brescia, Italy a r t i c l e i n f o a b s t r a c t Article history: Mandibular and maxillary nerve supplies are described in most anatomy textbooks. Accepted 20 September 2011 Nevertheless, several anatomical variations can be found and some of them are clinically relevant. Keywords: Several studies have described the anatomical variations of the branching pattern of the trigeminal nerve in great detail. The aim of this review is to collect data from the literature Mandibular nerve and gives a detailed description of the innervation of the mandible and maxilla. Maxillary nerve We carried out a search of studies published in PubMed up to 2011, including clinical, Anatomical variations anatomical and radiological studies. This paper gives an overview of the main anatomical variations of the maxillary and mandibular nerve supplies, describing the anatomical variations that should be considered by the clinicians to understand pathological situations better and to avoid complications associated with anaesthesia and surgical procedures. # 2011 Elsevier Ltd. -
Anatomical Variations of the Greater Palatine Nerve in the Greater Palatine Canal
Anatomical Variations of the Greater Palatine Nerve in the Greater Palatine Canal Najmus Sahar Hafeez, MD, MSc; Sugantha Ganapathy, MD, FRCPC; Rakesh Sondekoppam, MD; Marjorie Johnson, PhD; Peter Merrifield, PhD; Khadry A. Galil, DDS, DO&MF Surg, PhD, FAGD, FADI, Cert. Periodontist Posted on July 21, 2015 Tags: diagnosis oral surgery Cite this as: J Can Dent Assoc 2015;81:f14 ABSTRACT The greater palatine nerve and the greater palatine canal are common sites for maxillary anesthesia during dental and maxillo facial procedures. The greater palatine nerve is thought to course as a single trunk through the greater palatine canal, branching after its exit from the greater palatine foramen. We describe intracanalicular branching variations of the greater palatine nerve found in 8 of 20 embalmed dissection specimens. Such variation is previously unreported in the literature. We characterize the variations in branching pattern and discuss the possible implications for clinical practice. The greater palatine nerve (GPN), which is the continuation of the descending palatine nerve, innervates palatal tissues and the palatal gingiva posterior to the canines after passing through the greater palatine foramen. Anesthetising the GPN (i.e., GPN block) at the greater palatine foramen is common during procedures on the maxillary teeth and palate. The greater palatine canal also provides access for maxillary anesthesia in dental practice.1 Studies have suggested that the greater palatine neurovascular bundle is the most critical structure to be identified during subepithelial connective tissue palatal graft procedures.2 Multiple studies in clinical practice have demonstrated that a GPN block produces the most effective, consistent and prolonged analgesia following palatoplasty in children with cleft palate.3 Although a number of studies have shown anatomical variations in greater palatine foramen location, number and morphology,4,5 studies describing anatomical variations in the GPN within and outside the canal are sparse. -
Maxillary Nerve Variations and Its Clinical Significance
Sai Pavithra .R et al /J. Pharm. Sci. & Res. Vol. 6(4), 2014, 203-205 Maxillary Nerve Variations and Its Clinical Significance Sai Pavithra .R,Thenmozhi M.S Department of Anatomy, Saveetha Dental College Tamil nadu. Abstract: The aim of this review is to collect data from the literature and gives a detailed description of the innervation of the maxilla. We carried out a search of studies published in PubMed up to 2011, including clinical and anatomical studies .several articles has has been published regarding the anatomical variations of the maxillary nerve supplies. The purpose of this paper is to demonstrate the variation in the paths and communications of the maxillary nerve which should be considered by the clinicians as nerve supply,assumed prime importance to oral surgeons to understand better and to avoid complications associated with anaesthesia and surgical procedures. Key words: maxillary nerve, clinical variations THE MAXILLARY NERVE: foramen is usually a single foramen but several studies 1. Anatomical variations of the maxillary nerve supply. have proven to have two or three foramen[2-8]. A low 2. Anatomical variations of the infraorbital nerve. percentage (4.7%) was observed during a study on 3. Anatomical variations of the superior alveolar nerve 1064 skulls, with a higher frequency on the left side, 4.Anatomical variations of the greaterpalatine nerve. both in male and in female skulls[9]. The distance from 5. Anatomical variations of the nasopalatine nerve. the infraorbital foramen to the inferior border of the [10-13] orbital rim is from 4.6 to 10.4 mm . AXILLARY NERVE: Since the infraorbital nerve block is often used to The maxillary nerve is a sensory nerve. -
A Cone Beam Computed Tomographic Analysis of the Greater Palatine Foramen in a Cohort of Sri Lankans T
Journal of Oral Biology and Craniofacial Research 9 (2019) 306–310 Contents lists available at ScienceDirect Journal of Oral Biology and Craniofacial Research journal homepage: www.elsevier.com/locate/jobcr A cone beam computed tomographic analysis of the greater palatine foramen in a cohort of Sri Lankans T ∗ Manil C.N. Fonsekaa, , P.V.Kalani S. Hettiarachchib, Rasika M. Jayasinghec, Ruwan D. Jayasingheb, C. Deepthi Nanayakkarad a Department of Restorative Dentistry, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka b Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka c Department of Prosthetic Dentistry, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka d Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka ARTICLE INFO ABSTRACT Keywords: Objectives: To determine the size and position of the Greater Palatine Foramen using CBCT Greater palatine foramen Materials and method: GPF was evaluated on 50 CBCT's which were obtained at the Division of Oral Medicine Conebeam CT and Radiology, FDS, University of Peradeniya, The distance of each GPF to the mid maxillary suture (MMS), Morphometric Anterior Nasal Spine (ANS), relationship of the GPF to the molar teeth and diameter were measured in different orthogonal planes using measurement tools integrated to the CBCT software. Results: Mean diameter of the GPF in females and males were 3.72 mm for the right and 3.31 mm for the left and 4.56 mm and 4.30 mm. The antero-posterior distance measured from the ANS to mid GPF in axial sections among females was 45.70 mm and 44.81 mm for the right and left respectively whereas for males it was 48.37 mm and 47.6 mm. -
Trigeminal Nerve Trigeminal Neuralgia
Trigeminal nerve trigeminal neuralgia Dr. Gábor GERBER EM II Trigeminal nerve Largest cranial nerve Sensory innervation: face, oral and nasal cavity, paranasal sinuses, orbit, dura mater, TMJ Motor innervation: muscles of first pharyngeal arch Nuclei of the trigeminal nerve diencephalon mesencephalic nucleus proprioceptive mesencephalon principal (pontine) sensory nucleus epicritic motor nucleus of V. nerve pons special visceromotor or branchialmotor medulla oblongata nucleus of spinal trigeminal tract protopathic Segments of trigeminal nereve brainstem, cisternal (pontocerebellar), Meckel´s cave, (Gasserian or semilunar ganglion) cavernous sinus, skull base peripheral branches Somatotopic organisation Sölder lines Trigeminal ganglion Mesencephalic nucleus: pseudounipolar neurons Kovách Motor root (Radix motoria) Sensory root (Radix sensoria) Ophthalmic nerve (V/1) General sensory innervation: skin of the scalp and frontal region, part of nasal cavity, and paranasal sinuses, eye, dura mater (anterior and tentorial region) lacrimal gland Branches of ophthalmic nerve (V/1) tentorial branch • frontal nerve (superior orbital fissure outside the tendinous ring) o supraorbital nerve (supraorbital notch) o supratrochlear nerve (supratrochlear notch) o lacrimal nerve (superior orbital fissure outside the tendinous ring) o Communicating branch to zygomatic nerve • nasociliary nerve (superior orbital fissure though the tendinous ring) o anterior ethmoidal nerve (anterior ethmoidal foramen then the cribriform plate) (ant. meningeal, ant. nasal, -
Peripheral Nervous System Peripheral Nervous System Comprises: A) Cranial Nerves: 12 in Number, Arise Mainly from Brain Stem
Peripheral nervous system Peripheral nervous system comprises: A) Cranial nerves: 12 in number, arise mainly from brain stem. B) Spinal nerves: arise from spinal cord, varies in number according to species. C) Autonomic nervous system : 1-Sympathetic (thoracolumbar) division. 2-Parasympathetic (craniosacral) division. Cranial nerves They are 12 pairs General features: – They are known by roman numbers from (rostral to caudal) . – Some nerves take their names according to: * Function as olfactory and abducent * Distribution as facial and hypoglossal * Shape as trigeminal. - All cranial nerves have superficial origins on ventral aspect of brain except trochlear nerve originates from dorsal aspect of brain. -All cranial nerves except first one originate from brain stem. - Each nerve emerges from cranial cavity through a foramen. - All cranial nerves except vagus distributed generally in head region. - 3,7,9,10 cranial nerves carry parasympathetic fibers. - Classification of cranial nerves: - They are classified according to the function into: 1-Sensory nerves: 1,2,8. 2-Motor nerves: 3,4,6,11,12. 3-Mixed nerves: 5,7,9,10. I- Olfactory nerves Type: • Sensory for smell. • Represented by bundles of nerve fibers, not form trunk. Origin: • Central processes of olfactory cells of olfactory region of nasal cavity. Course: • They pass though cribriform plate to join olfactory bulb. Vomeronasal nerve: • It arises from vomeronasal organ ,passes through medial border of cribriform plate to terminate in olfactory bulb. II- Optic nerve Type: • Sensory for vision. Origin: • Central processes of ganglion cells of retina. Course: • Fibers converge toward optic papilla forming optic nerve, emerges from eyeball. • Then passes through optic foramen and decussates with its fellow to form optic chiasma. -
Morphometric Evaluation and Clinical Implications of the Greater Palatine
Surgical and Radiologic Anatomy (2019) 41:551–567 https://doi.org/10.1007/s00276-019-02179-x ORIGINAL ARTICLE Morphometric evaluation and clinical implications of the greater palatine foramen, greater palatine canal and pterygopalatine fossa on CBCT images and review of literature İlhan Bahşi1 · Mustafa Orhan1 · Piraye Kervancıoğlu1 · Eda Didem Yalçın2 Received: 1 August 2018 / Accepted: 3 January 2019 / Published online: 8 January 2019 © Springer-Verlag France SAS, part of Springer Nature 2019 Abstract Introduction The pterygopalatine fossa (PPF) infiltration is performed to reduce blood flow during endoscopic sinus surgery and septorhinoplasty, as well as to control posterior epistaxis and provide regional anesthesia in dental procedures. PPF infiltration performed with consideration of the morphometrics of greater palatine foramen (GPF), greater palatine canal (GPC) and PPF would increase the success of the procedure and reduce the risk of complications. The aim of this study is to investigate the GPF, GPC, lesser palatine foramen (LPF), lesser palatine canal (LPC) and PPF morphology via the images obtained by CBCT, to provide information for interventional procedures. Materials and methods GPF, GPC, LPF, LPC and PPF were morphometrically evaluated retrospectively in CBCT images of 75 female and 75 male cases by Planmeca Romexis program. The 19 parameters were measured on these images. Results These parameters were evaluated statistically. The comparison of these parameters by genders revealed significant differences in distances between GPC–PC, PC–IOF, LPC–GPF, GPF–MS in the coronal and transverse planes, the distance between GPF and the occlusal plane of the teeth, GPF–PNS, GPF–IF and TD-GPF, and in the area of GPF. -
Maxillary Nerve Block Via the Greater Palatine Canal: an Old Technique Revisited
Review Article Maxillary nerve block via the greater palatine canal: An old technique revisited Georges Aoun1,2, Ibrahim Zaarour1, Sayde Sokhn3, Ibrahim Nasseh3 1Department of Oral Pathology and Diagnosis, 2Department of Fundamental Sciences and 3Department of Dentomaxillofacial Radiology and Imaging, School of Dentistry, Lebanese University, Beirut, Lebanon Corresponding author (email: <[email protected]>) Dr. Georges Aoun, Departments of Oral Pathology and Diagnosis and Fundamental Sciences, School of Dentistry, Lebanese University, Beirut, Lebanon. Abstract Background: Maxillary nerve block through the greater palatine canal is rarely adopted by dental practitioners due to lack of experience in the technique at hand which may lead into several complications. Nevertheless, it is an excellent method to achieve profound anesthesia in the maxilla. This review focuses on the anatomy as well as the indications, contraindications, and complications associated with this technique. Materials and Methods: A literature search was performed using the scientific databases (PubMed and Google Scholar) for articles published up to December 2014 in English, using the key words “maxillary nerve block via the greater palatine canal.” A total of 34 references met the inclusion criteria for this review and were selected. Conclusion: Block of the maxillary nerve through the greater palatine canal is a useful technique providing profound anesthesia in the hemi‑maxilla, if practiced properly. Key words: Anesthesia, cone beam computed tomography, greater -
Pterygo Fossa
Pterygopalatine Fossa Alex Meredith, PhD The ptergopalatine fossa is located medial (deep) to the infratemporal region. From a lateral view, its shape can be thought to outline a quadrilateral whose inferior aspect is narrower than its top. The walls of the pterygopalatine fossa can be imagined to be constituted by four such quadrilaterals. The pterygopalatine fossa contains the pterygopalatine ganglion, nerve branches to and from the ganglion, and the third part of the maxillary artery and its branches. Fig 1 Roof: None, but is related, superiorly, to the greater wing of sphenoid. Walls: each is formed by portions of two cranial bones: 1. Lateral: Pterygoid plate, posteriorly Maxilla, anteriorly 2. Anteriorly: Maxilla, laterally Palatine, medially 3. Medial: Palatine, anteriorly Body of Sphenoid, posteriorly 4. Posterior: Body of Sphenoid, medially Pterygoid plate, laterally Floor: None, but the fossa is directly continuous with a canal in the palatine bone (“palatine canal”) that leads inferiorly to the greater and lesser palatine foramina. Foramina: 1. Lateral: Pterygomaxillary fissure, the opening between the pterygoid plate and posterior surface of the maxilla. 2. Anterior: Inferior orbital fissure: a groove in the maxilla 3. Medial: Sphenopalatine foramen: the body of the sphenoid bone meets a notch in the palatine bone. 4. Posterior: a. Pharvngeal canal (often a groove): at the juntion of posterior and medial walls, runs posterior medial direction towards the nasopharynx and auditory tube. b. Pterygoid canal: runs posteriorly through the base of the phenoid sinus. c. Foramen rotundum: enters posterosuperiorly. Fig 2 Numbers 114 below correspond with figure 2. 1. Maxillary a., enters through pteygomaxillary fissure.