The following 3 techniques may be used to perform a maxillary nerve block:
1. High tuberosity approach,
2. Greater palatine canal approach,
3. Coronoid approach.
The high tuberosity approach blocks the nerve as it courses along the pterygopalatine fossa. It anesthetizes the hemimaxilla on the side of the block, including the maxillary teeth; the buccal, gingival, and periodontal tissues; and the soft and hard palate.
The greater palatine canal approach blocks the maxillary nerve as it travels through the pterygopalatine fossa. This approach is associated with a higher rate of success; however, it is contraindicated if the canal cannot be located or negotiated.
The greater palatine foramen is usually located on the palate, 1 cm medial and adjacent to the second molar teeth.
A cotton swab may be pressed on the palate to find the depression caused by the foramen.
The coronoid approach is better performed under imaging guidance. It differs from the other 2 approaches in that its access is external.
The coronoid notch of the mandible is identified by having the patient open and close the mouth and palpating in front of and below the tragus
► See also: DENTAL ANESTHESIA : Mandibular Anesthesia : Gow-Gates technique
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