PALATAL ANESTHESIA

Greater Palatine Nerve Block

Anterior Palatine Nerve

Posterior portion of hard palate and
overlying soft tissues

Anteriorly to 1st premolar

Medially to midline
 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)
 Greater Palatine Nerve Block

Advantages
Minimizes penetrations and discomfort
Minimizes volume of solution (0.5 ml)

Disadvantages
Limited hemostasis
Potentially traumatic
 Greater Palatine Nerve Block

Alternatives
Local infiltration in each area
Maxillary Nerve Block

Aspiration
< 1% positive
 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
 Greater Palatine Nerve Block

Precautions
Do not enter canal

Signs & symptoms

Numb posterior palate; painfree treatment

Safety features
Bone contacted; aspiration
 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
 Greater Palatine Nerve Block

Failure
Overlap of fibers from Nasopalatine nerve
Injection too anterior

Complications
Soft tissue ischemia / necrosis
Post injection pain, hematoma
NASOPALATINE NERVE BLOCK
 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)
 Nasopalatine Nerve Block

Advantages
Minimizes needle penetrations
Minimizes volume of solution (0.4 ml)

Disadvantages
Limited hemostasis
Potentially traumatic
 Nasopalatine Nerve Block

Alternatives
Local infiltration
Maxillary Nerve Block

Aspiration
< 1% positive
 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
 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
 Nasopalatine Nerve Block

Failure
May be only unilateral
May have overlap with Greater Palatine

Complications
Ischemia, tissue necrosis
Others rare