Local Anaesthesia in Dentistry by Jacques A. Baart & Henk S. Brand

Author:Jacques A. Baart & Henk S. Brand
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

It is not always easy to find the entrance to the foramen. Moreover, inserting the needle roughly can lead to long-term damage of the nerve. Finally, if the patient has a small maxilla, the anaesthetic fluid may reach the parasympathetic sphenopalatine ganglion so that unintended side effects may occur, such as diplopia (double vision).

7.2 Infraorbital Nerve Block

The infraorbital nerve runs almost horizontally through the canal in the orbital floor until it leaves through the infraorbital foramen, approximately 5–10 mm caudally to the infraorbital rim. The nerve supplies sensibility to the nostril, cheek, lower eyelid, upper lip, gingiva and upper frontal teeth.

An infraorbital nerve block is suitable for the dental treatment and surgery of frontal teeth. A vasoconstrictor containing anaesthetic is used for this block, applied with a customary cartridge syringe with 25-gauge needle of 35 mm. There are two intraoral methods for blocking the infraorbital nerve. The first involves the needle being positioned approximately 0.5 cm laterally from P2sup, whilst the other method involves the needle being inserted approximately 1 cm from the alveolar process of Csup. The lip is lifted with the thumb, and the index finger of the same hand feels the infraorbital rim extraorally. The needle is then moved in the direction of the finger. With the method in which the needle is inserted in the buccal sulcus at the level of the Csup, the needle is directed towards the pupil of the eye (◘ Fig. 7.3). With the ‘P2sup method’, the needle is inserted in the direction of the longitudinal axis of this tooth. After about 2 cm, the needle will make contact with the bone at the level of the infraorbital foramen. The unaltered position of the index finger prevents the needle from being fed in so as far as that it touches the eyelid. A depot of half a cartridge is enough.

Fig. 7.3 a–d Photo of skull a, drawing b and photo of patient c show block anaesthesia of the infraorbital nerve. The needle is inserted 1 cm vestibular to the Csup right and is inserted in the direction of the pupil. The index finger of the non-injecting hand rests on the infraorbital rim. The injection is given after aspiration. Photo of patient d shows an alternative method, where the needle is inserted straight up from the buccal sulcus of the P1-P2sup right region so that it stops at the level of the infraorbital foramen

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