Deck 12: Injections for Maxillary Pain Control

Question 1

Match the following :

-Dental plexus

A) Near nerve endings
B) Swelling
C) Opening through bone
D) Nerves around teeth
E) Bony protrusion
F) Bruising
G) Area numbed
H) Passageway
I) Piercing point
J) Target

Answer 1

Nerves around teeth

Question 2

Match the following :

-Deposition site

A) Near nerve endings
B) Swelling
C) Opening through bone
D) Nerves around teeth
E) Bony protrusion
F) Bruising
G) Area numbed
H) Passageway
I) Piercing point
J) Target

Answer 2

Target

Question 3

Match the following :

-Edema

A) Near nerve endings
B) Swelling
C) Opening through bone
D) Nerves around teeth
E) Bony protrusion
F) Bruising
G) Area numbed
H) Passageway
I) Piercing point
J) Target

Answer 3

Swelling

Question 4

Match the following :

-Eminence

A) Near nerve endings
B) Swelling
C) Opening through bone
D) Nerves around teeth
E) Bony protrusion
F) Bruising
G) Area numbed
H) Passageway
I) Piercing point
J) Target

Question 5

Match the following :

-Field of anesthesia

A) Near nerve endings
B) Swelling
C) Opening through bone
D) Nerves around teeth
E) Bony protrusion
F) Bruising
G) Area numbed
H) Passageway
I) Piercing point
J) Target

Question 6

Match the following :

-Foramen

A) Near nerve endings
B) Swelling
C) Opening through bone
D) Nerves around teeth
E) Bony protrusion
F) Bruising
G) Area numbed
H) Passageway
I) Piercing point
J) Target

Question 7

Match the following :

-Hematoma

A) Near nerve endings
B) Swelling
C) Opening through bone
D) Nerves around teeth
E) Bony protrusion
F) Bruising
G) Area numbed
H) Passageway
I) Piercing point
J) Target

Question 8

Match the following :

-Infiltration

A) Near nerve endings
B) Swelling
C) Opening through bone
D) Nerves around teeth
E) Bony protrusion
F) Bruising
G) Area numbed
H) Passageway
I) Piercing point
J) Target

Question 9

Match the following :

-Needle pathway

A) Near nerve endings
B) Swelling
C) Opening through bone
D) Nerves around teeth
E) Bony protrusion
F) Bruising
G) Area numbed
H) Passageway
I) Piercing point
J) Target

Question 10

Match the following :

-Penetration site

A) Near nerve endings
B) Swelling
C) Opening through bone
D) Nerves around teeth
E) Bony protrusion
F) Bruising
G) Area numbed
H) Passageway
I) Piercing point
J) Target

Question 11

The group of nerves innervating the pulp of the tooth, facial areas of the gingiva, periodontal ligament, and alveolus is called the ________.

Question 12

Field block or ________ injections are indicated when procedures are confined to one or two teeth or to tissues in limited area.

Question 13

The facial bone of the maxilla is relatively ________ which allows for ease of diffusion of local anesthetics.

Question 14

The optimum site of penetration for infiltration injections is at the ________.

Question 15

A bony ridge or ________ can be palpated overlying the facial roots of maxillary teeth.

Question 16

The ASA nerve is a branch of the ________ division of the trigeminal nerve.

Question 17

An anatomical variation that can complicate an MSA injection is the presence of a large ________.

Question 18

The PSA nerve branches from the maxillary nerve in the ________ fossa prior to entering the infraorbital canal.

Question 19

The pathway of the needle ________ the long axis of the tooth in an infiltration injection.

Question 20

The deposition site for an infiltration injection is at the ________ of the tooth.

Question 21

The optimal site of penetration for an ASA injection is at the height of the mucobuccal fold ________ to the canine eminence.

Question 22

The depth of penetration for an ASA injection ranges from ________ mm.

Question 23

A minimum volume (in milliliters) of anesthetic solution needed to achieve anesthesia with an ASA injection is typically ________ mL.

Question 24

The needle pathway of an MSA injection parallels the long axis of the ________.

Question 25

The ________ nerve block is indicated for pain management of anterior and premolar teeth in one quadrant.

Question 26

The needle pathway for an IO injection has been described as oriented along a line parallel to the ________.

Question 27

The PSA injection is indicated for pain management of ________ in one quadrant.

Question 28

The optimum depth of insertion for a PSA injection is ________ mm.

Question 29

The angle of insertion for the PSA injection is ________ degrees to the maxillary occlusal table and the midsagittal planes.

Question 30

Soft tissue retraction for a PSA injection is both ________ to allow for good visibility.

Question 31

The correct depth of penetration for a V2 injection is ________ mm.

Question 32

The optimum depth of insertion for a V2 injection is ________ mm.

Question 33

Which of the following best explains why infiltration techniques are highly successful in the maxilla?

A) Minimal penetration depths
B) Ease of diffusion through bone
C) Multiple nerves in the dental plexus
D) Volumes of anesthetic delivered

Question 34

Which of the following is a possible anatomical barrier to the success of an infiltration technique?

A) Root angulations
B) Syringe angulations
C) Frenal attachments
D) Large exostoses

Question 35

Which of the following best explains the needle choice for an infiltration of a maxillary lateral incisor?

A) 30 gauge long for patient comfort and to assure deposition of solution near the apex
B) 30 gauge short for patient comfort and high risk of positive aspiration
C) 27 gauge short based on the low risk of positive aspiration
D) 25 gauge extra short due to shallow root depth

Question 36

What is a typical minimum volume of anesthetic solution necessary for an infiltration of tooth number 7?

A) 0.4 mL
B) 0.6 mL
C) 1.8 mL
D) 9.0 mL

Question 37

What is the typical minimum volume of anesthetic solution necessary for an infiltration of a maxillary central incisor?

A) 0.4 mL
B) 0.6 mL
C) 1.8 mL
D) 9.0 mL

Question 38

When an infiltration injection is unsuccessful, it may be helpful to:

A) Visualize and re-inject with a longer needle
B) Visualize, palpate, check radiographs and reassess the technique
C) Establish contact with bone before administering additional anesthetic
D) Repeat the same injection and deposit more solution

Question 39

Which of the following injections is not an alternate for an unsuccessful infiltration on a maxillary canine?

A) IO
B) ASA
C) MSA
D) PASA

Question 40

Which one of the following injections is the best alternative for an unsuccessful infiltration of a maxillary first molar?

A) PSA
B) MSA
C) IO
D) AMSA

Question 41

Which injection will most easily remedy cross-over innervation to a central incisor?

A) Infiltration over the same side central incisor with a larger volume of solution
B) Infiltration over the opposite side central incisor
C) ASA nerve block
D) Bilateral AMSA nerve blocks

Question 42

Which of the following describes the ASA nerve?

A) Terminal branch of the maxillary nerve exiting the infraorbital foramen to supply sensation to the upper lip, lower side of the nose, and dental plexus of the canine and incisors
B) Terminal branch of the maxillary nerve branching from the infraorbital nerve within the infraorbital canal 6 to 10 mm prior to the infraorbital foramen to supply sensation to the dental plexus of the canine, central and lateral incisors
C) Descends along the external surface of the maxilla and supplies sensation to the dental plexus of the canine, central and lateral incisors
D) Descends through anterior wall of the maxillary sinus to supply sensation to the dental plexus of the premolars, canine, lateral and central incisors

Question 43

The field of anesthesia of an ASA nerve block includes each of the following except

A) Upper lip, cheek, lower nose
B) Pulps of the maxillary central incisor through canine
C) Facial periodontium of central incisor through canine
D) Lingual periodontium of central incisor through canine

Question 44

Which of the following is an anatomical landmark for an ASA injection?

A) Mucobuccal fold mesial to the first premolar
B) Canine fossa distal to the canine eminence
C) Canine fossa anterior to the canine eminence
D) Mucobuccal fold superior to the canine eminence

Question 45

What is the depth of penetration for an ASA nerve block?

A) 1 to 3 mm
B) 3 to 6 mm
C) 6 to 9 mm
D) 9 to 12 mm

Question 46

What is an accepted minimal volume of anesthetic solution for an ASA nerve block?

A) 0.6 mL
B) 0.9 mL
C) 0.9 mL to 1.8 mL
D) 1.2 to 1.6 mL

Question 47

Which is the best explanation for incomplete anesthesia of the central incisor following an ASA nerve block?

A) Cross-innervation from the opposite side of injection
B) Inadequate depth of penetration
C) Poor angulation of the needle
D) Accessory innervation of the MSA nerve

Question 48

Studies have demonstrated the absence of the MSA nerve in:

A) 10% to 28% of individuals
B) 15% to 50% of individuals
C) 28% to 52% of individuals
D) 50% to 72% of individual

Question 49

What anatomical feature may restrict the penetration site for an MSA injection?

A) Canine eminence
B) Low mucogingival junction
C) Maxillary tuberosity
D) Zygomaticoalveolar crest

Question 50

In the absence of an MSA nerve, which of the following two nerves may innervate the premolars and the mesiobuccal root of the first molar?

A) Infraorbital and posterior superior alveolar
B) Infraorbital and anterior Superior alveolar
C) Anterior superior alveolar and posterior superior alveolar
D) Anterior superior alveolar and greater palatine

Question 51

Which of the following correctly describes the needle pathway for an MSA injection?

A) The needle advances distal to the second premolar through thin mucosal tissue to superficial fascia consisting of dense connective tissue, microvasculature, and nerve endings.
B) The needle advances parallel to the long axis of the first premolar through thin mucosal tissue to superficial fascia consisting of loose connective tissue, microvasculature, and nerve endings.
C) The needle advances parallel to the long axis of the second premolar through thin mucosal tissue to superficial fascia consisting of loose connective tissue, microvasculature, and nerve endings.
D) The needle advances perpendicular to the long axis of the second premolar at the height of the mucobuccal fold through thin mucosal tissue to superficial fascia consisting of loose connective tissue, microvasculature, and nerve endings.

Question 52

What is the depth of penetration for a MSA nerve block?

A) 1 to 3 mm
B) 3 to 6 mm
C) 5 to 8 mm
D) 9 to 12 mm

Question 53

What is an adequate range of volumes for MSA nerve blocks?

A) 0.4 to 0.9 mL
B) 0.9 to 1.2 mL
C) 1.2 to 1.8 mL
D) 1.6 to 1.8 mL

Question 54

In a typical adult, how far below the inferior orbital ridge is the IO deposition site located?

A) 8 to 10 mm
B) 6 to 12 mm
C) 2 to 4 mm
D) 1to 2 mm

Question 55

The field of anesthesia of an IO nerve block includes the:

A) Pulps of maxillary central incisors through canine, and upper lip, side of nose, and lower eyelid
B) Pulps and periodontium of maxillary central incisors through canine and premolars, mesial buccal root of the first molar, upper lip, side of nose, and lower eyelid
C) Pulps of maxillary incisors, canine and premolars, upper lip, and side of nose
D) Pulps and maxillary periodontium of incisors, canine, premolars

Question 56

Which of the following teeth are anesthetized by an IO injection technique?

A) 8, 9, 10, 11, 12, 13
B) 6, 7, 8, 9, 10, 11
C) 8, 9, 10, 11, 12, 13, and sometimes the MB root of 14
D) 8, 9, 10

Question 57

Which of the following provides the most accurate description of the field of anesthesia for an IO injection?

A) Pulps of the maxillary first and second premolars and their facial gingiva, the periodontal ligament, alveolar bone, and in some individuals, the mesiobuccal root of the first molar
B) Pulps of the maxillary central incisors through the canines, premolars, and their facial periodontium; the lower eyelid, lateral aspect of nose, and upper lip; and in some individuals, the mesiobuccal root of the maxillary first molar
C) Pulps of the maxillary central incisor through the canines on the injected side and their facial periodontium, and due to diffusion of anesthetic solution some terminal branches of the facial nerve
D) Pulps of the maxillary first and second molars and their facial gingival, periodontal ligament, and alveolar bone

Question 58

What is a minimal volume of anesthetic solution deposited for an IO nerve block?

A) 0.6 mL
B) 0.9 mL
C) 0.9 mL to 1.8 mL
D) 1.2 to 1.6 mL

Question 59

The PSA nerve branches from the maxillary nerve within the:

A) Temporomandibular fossa
B) Maxillary tuberosity
C) Infraorbital canal
D) Pterygopalatine fossa

Question 60

Small PSA foramina are located on the

A) Posterior surface of the maxillary tuberosity
B) Medial surface of the maxillary tuberosity
C) Distal wall of the pterygopalatine fossa
D) Inferior surface of the zygomatic arch

Question 61

What is the correct deposition site for a PSA nerve block?

A) Anterior to the zygomatic process of the maxilla
B) Posterior to the zygomatic bone of the maxilla
C) Posterior surface of the maxillary tuberosity
D) Superior to the apex of the mesial buccal root of the maxillary second molar

Question 62

What is the optimum depth of penetration for a PSA nerve block?

A) 6 mm
B) 9 mm
C) 16 mm
D) 22 mm

Question 63

Which nerve may provide accessory innervation to the palatal roots of the maxillary molars and to the premolars?

A) MSA
B) IA
C) GP
D) IO

Question 64

Which of the following maxillary injection techniques has the highest risk of hematoma?

A) ASA
B) IO
C) AMSA
D) PSA

Question 65

What is the most common cause of failure of a PSA nerve block?

A) Deposition of solution too far away from the PSA foramina
B) Incorrect needle length and gauge
C) Inadequate volume of solution
D) Intravascular injection

Question 66

The PSA injection technique may be contraindicated in patients with:

A) Clotting disorders due to risk of hematoma
B) Diabetes due to high risk of infection
C) TMD because of difficulty opening the mouth wide
D) Missing maxillary second molars due to difficulty locating the posterior aspect of the tuberosity

Question 67

The maxillary nerve block provides unilateral anesthesia to the following except

A) pulps and periodontium of maxillary teeth
B) soft and hard palatal tissues
C) upper and lower lips, cheek, upper and lower eyelids
D) upper lips, cheek, lower eyelids, lateral aspect of nose

Question 68

Which maxillary nerve block technique has the highest risk of hematoma formation?

A) High-tuberosity
B) Greater palatine
C) Extra oral approach
D) Pterygopalatine canal

Question 69

What is the correct penetration depth for a maxillary nerve block for a palatal approach?

A) 16 mm
B) 20 mm
C) 30 mm
D) 32 mm

Question 70

What is the preferred needle length and gauge for maxillary nerve block with a palatal approach?

A) Short, 25 gauge
B) Short, 30 gauge
C) Long, 27 gauge
D) Long, 25 gauge

Question 71

Which of the following describes the penetration site for a facial approach to a maxillary nerve block?

A) Height of the mucobuccal fold over the distobuccal aspect of the maxillary second molar
B) Height of the mucobuccal fold distal to the zygomatic process
C) Lateral to the height of the mucobussal fold posterior to the zygomatic bone of the maxilla
D) Lateral to the height of the mucobuccal fold over the mesiobuccal aspect of the maxillary second molar

Question 72

Which of the following maxillary injection techniques has the highest risk of hematoma?

A) IO
B) AMSA
C) PSA
D) V2

Question 73

Describe the field of anesthesia for the infraorbital (IO) nerve block.

Question 74

Describe the field of anesthesia for the PSA nerve block.

Question 75

Discuss techniques factors that increase the risk of hematoma in PSA injections.

Question 76

Discuss possible complications of the tuberosity-approach maxillary nerve block.

Question 77

Color in the field of anesthesia and list the structures anesthetized by an infiltration of #7.
.

Question 78

Color in the field of anesthesia and list the structures anesthetized by an ASA nerve block.

Question 79

Color in the field of anesthesia and list the structures anesthetized by an MSA nerve block.

Question 80

Color in the field of anesthesia and list the structures anesthetized by an IO nerve block.