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 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

1. Seat patient with head against stretcher back or wall to avoid head jerking
2. Position yourself on the ipsilateral side: the nerves run lateral to the alveolar ridge.
3. 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

1. Retract upper lip anteriorly and superiorly.
2. At apex of canine, insert the syringe at 45 degree angle posteriorly, superiorly.
3. Advance several millimeters until contact with bone.
4. Draw back to ensure you have not accessed the vascular space.
5. 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

1. Retract upper lip laterally and superiorly.
2. Between apices of premolar and first molar, insert the syringe at 45 degree angle posteriorly, superiorly, medially.
3. Advance several millimeters until contact with bone.
4. Draw back to ensure you have not accessed the vascular space.
5. 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

1. Retract upper lip laterally and superiorly.
2. At root of upper second molar, insert the syringe at 45 degree angle posteriorly, superiorly, medially.
3. Advance 1-2cm until contact with bone.
4. Draw back to ensure you have not accessed the vascular space.
5. 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

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