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