View source for Nerve Block: Superior Alveolar

==Overview==
There is no single block location for the superior alveolar nerves (anterior, middle, posterior) as they leave from the infraorbital and maxillary tuberosity prior to forming a plexus in the maxillary gingiva. This is in contrast to the [[Nerve Block: Inferior Alveolar|inferior aveolar nerve block]]. Essentially these are field blocks.

==Indications==
*dental pain (e.g. fracture, caries)
*periapical abscess
*dentoaveolar trauma
==Contraindications==
*overlying infection
*allergy to local anesthetic
==Equipment Needed==
*local anesthetic (e.g. lidocaine+/-epinephrine, bupivicaine)
*25-27 gauge needle
*3-10mL syringe
*topical anesthetic
==Procedure==
===Preparation===
#Seat patient with head against stretcher back or wall to avoid head jerking
#Position yourself on the ipsilateral side: the nerves run lateral to the alveolar ridge.
#Consider topical anesthesia.
===Anterior Superior Alveolar===
*descends from infraorbital nerve
*innervates ipsilateral incisors and canine; may provide some sensation to contralateral medial incisor
*can reliably be achieved with [[Nerve Block: Infraorbital]]

#Retract upper lip anteriorly and superiorly.
#At apex of canine, insert the syringe at 45 degree angle posteriorly, superiorly.
#Advance several millimeters until contact with bone.
#Draw back to ensure you have not accessed the vascular space.
#Inject 2-3mL anesthetic into the tissue and allow to diffuse.
===Middle Superior Alveolar===
*may branch from infraorbital nerve or maxillary nerve: may run parallel to posterior or anterior superior alveolar nerves
*innervates ipsilateral premolars, first molar
*can frequently be achieved with [[Nerve Block: Infraorbital]]

#Retract upper lip laterally and superiorly.
#Between apices of premolar and first molar, insert the syringe at 45 degree angle posteriorly, superiorly, medially.
#Advance several millimeters until contact with bone.
#Draw back to ensure you have not accessed the vascular space.
#Inject 2-3mL anesthetic into the tissue and allow to diffuse.

===Posterior Superior Alveolar===
*branches from maxillary nerve, exits below maxilla; '''not''' through infraorbital groove
*innervates ipsilateral molars; may provide partial innervation to first molar

#Retract upper lip laterally and superiorly.
#At root of upper second molar, insert the syringe at 45 degree angle posteriorly, superiorly, medially.
#Advance 1-2cm until contact with bone.
#Draw back to ensure you have not accessed the vascular space.
#Inject 2-3mL anesthetic into the tissue and allow to diffuse.
==Complications==
*hemorrhage
*hematoma
*neurovascular trauma
*intravascular injection
*allergy
==See Also==
*[[Nerve and regional blocks (main)]]
*[[Nerve Block: Inferior Alveolar]]
*[[Nerve Block: Infraorbital]]
*[[Local anesthetic systemic toxicity]]

==External Links==
*[Peer-Reviewed, Web Publication] Karalius V,  Cunningham, A. (2020, Jan 20). Oral Nerve Blocks. [NUEM Blog. Expert Commentary by Friedman, B]. Retrieved from http://www.nuemblog.com/blog/oralnerveblock

==References==
<references/>

Roberts, James R., Catherine B. Custalow, Todd W. Thomsen, and Jerris R. Hedges. 2014. Roberts and Hedges' clinical procedures in emergency medicine. 6th ed


[[Category:Procedures]]
[[Category:ENT]]