1. PALATAL ANESTHESIA

2. Greater Palatine Nerve Block
Anterior Palatine Nerve
Posterior portion of hard palate and overlying soft tissues
Anteriorly to 1st premolar
Medially to midline

5. Greater Palatine Nerve Block
Indications
Pain control in posterior palatal hard and/or soft tissues
Contraindications
Inflammation / infection at injection site
Only small area necessary (eg. 1-2 teeth)

6. Greater Palatine Nerve Block
Advantages
Minimizes penetrations and discomfort
Minimizes volume of solution (0.5 ml)
Disadvantages
Limited hemostasis
Potentially traumatic

7. Greater Palatine Nerve Block
Alternatives
Local infiltration in each area
Maxillary Nerve Block
Aspiration
< 1% positive

8. Greater Palatine Nerve Block
Landmarks
Greater palatine foramen
Junction of alveolus and palatine bone
Area of Insertion
Soft tissue anterior to foramen, from opposite side

9. Greater Palatine Nerve Block
Precautions
Do not enter canal
Signs & symptoms
Numb posterior palate; painfree treatment
Safety features
Bone contacted; aspiration

11. Greater Palatine Nerve Block
Technique
Position - open wide, extend & turn head
Cotton swab - identify landmarks, topical
Approach - bevel to tissue, advance to bone
Aspirate; inject 0.5 ml slowly

14. Greater Palatine Nerve Block
Failure
Overlap of fibers from Nasopalatine nerve
Injection too anterior
Complications
Soft tissue ischemia / necrosis
Post injection pain, hematoma

15. NASOPALATINE NERVE BLOCK

17. Nasopalatine Nerve Block
Indications
Pain control in anterior hard and/or soft tissues
Contraindications
Inflammation / infection at injection site
Only small area necessary (eg. 1-2 teeth)

18. Nasopalatine Nerve Block
Advantages
Minimizes needle penetrations
Minimizes volume of solution (0.4 ml)
Disadvantages
Limited hemostasis
Potentially traumatic

19. Nasopalatine Nerve Block
Alternatives
Local infiltration
Maxillary Nerve Block
Aspiration
< 1% positive

20. Nasopalatine Nerve Block
Precautions
Do not inject directly into papilla/canal
Inject slowly, with small volume
Signs / symptoms
Numb anterior palate; painfree treatment
Safety features
Bone contacted; aspiration

21. Nasopalatine Nerve Block
Technique
Position - open wide, extend head
Landmarks - incisive papilla, central incisors
Approach - lateral to incisive papilla, starting with cotton swab, topical
Deposit approx. 0.4 ml / 30 sec

24. Nasopalatine Nerve Block
Failure
May be only unilateral
May have overlap with Greater Palatine
Complications
Ischemia, tissue necrosis
Others rare