Advanced Education In General Dentistry

Module 01: Advanced Pain Control and Sedation

Advanced Techniques and Local Anesthesia

Maxillary Nerve Block

Patients who present with a large canine space abscess make it very difficult for a clinician to achieve an adequate level of local anesthesia due to the abscess. In these cases, a maxillary nerve block may be helpful in providing good local anesthesia in order to perform treatment.

There are three basic techniques with the maxillary nerve block. The greater palitine canal approach is the technique used most frequently with greater success. The pterygopalitine, or greater palitine foramen, is located adjacent to the second molar on the hard palate.

  1. Place the patient in a semi-fallorous position, and hold the syringe and the needle at a 45-degree angle to the palate.
  2. Infiltrate around the greater palitine foramen to provide local anesthesia of the area to be injected.
  3. Once the injection area is anesthetized, slowly advance the needle approximately 30 mm, judged based upon the size of the patient.
  4. Rotate and aspirate again to be sure that the needle is not intravascular.
  5. Inject the carpule very slowly. Local anesthesia of a regional nerve block type will be obtained, and the patient's cheek on the affected side, gingiva, and dentition will soon become numb. As some patients may find this troubling, it is important to reassure the patient that the affect will last only a few hours.
Further Reading
Hawkins, J.M., Isen, D.
"Maxillary Nerve Block: Pterygopalitine Canal Approach"
Journal of the California Dental Association. (1998)

Alternative techniques of performing a maxillary nerve block include the Gaw-Gates, which is a condyle/neck approach. Open the patientŐs mouth wide, place one finger along the condyle externally, and place the thumb along the ascending ramus. Aim for the conidial with the injection intraorally. Finally aspirate and inject.

The Ashkinozy Closed Mouth technique follows the muco-gingival junction of the upper molars. This technique is useful in patients who have trismus due to pericoronitis from a third molar. Follow the muco-gingival junction of the upper molar, advancing the needle medial to the ramus of the mandible approximately 25 mm, aspirate and then inject. This technique works well, and frequently the patient's trismus will disappear as they become anesthetized.