Review of Nasopalatine Nerve Block

Nasopalatine Nerve Block Technique

What it numbs:

Nasopalatine nerve block provides anesthetic to the anterior portion of the hard palate both hard and soft tissues from the mesial of the right first premolar to the mesial of the left first premolar.  

Needle:

A 27-gauge short needle is recommended for the nasopalatine nerve block.  

Positioning:

Patient position is supine with mouth wide open.

For the nasopalatine nerve block, sit at a 9 or 10 o'clock position facing the same direction as the patient.  

Landmarks:

The landmarks are the central incisors, the incisive papilla and the incisive foramen.  

Technique injection options:

Dr Malamed offers two approaches to the injection:  

Original: The original technique uses one tissue penetration, just lateral to the incisive papilla on the palate at the midline, lingual to the maxillary   central incisors. Using topical anesthetic and pressure anesthesia.  

Three injection Technique:

  • For the multiple injection technique the first injection is an infiltration into the labial soft tissue between the two central incisors administer 0.3ml of anesthetic.

 

  • The second injection is an infiltration into the now numb papilla, between the two central incisors. Local anesthetic is administered until the tissue is blanched on the palatal soft tissues.

 

  • The third injection is the original nasopalatine nerve block technique. With this injection topical and pressure anesthesia are not required because patient should already feel the anesthetic effects.

Target area:

The target area and injection site is located into the soft tissue just lateral to the incisive papilla. Which is located at the midline, 10 mm lingual to the maxillary central incisors.

Do not inject directly into the incisive papilla as it will be very painful for the patient.

Dry tissue with 2×2 Gauze

Place cotton swab with topical anesthetic at the injection site for 1-2 minutes.

Apply pressure with cotton swab to directly on the incisive papilla.  

The bevel of the needle should be toward the soft tissue and inserted until bone is contacted. The needle may bow slightly.  

Aspirate, after negative aspiration slowly inject 1/8 or 0.3ml of the cartridge over 10 seconds.  

Observe patient after injection. Wait 2-3 minutes before stating dental procedure.  

Document:

Document in patient record, what injection you gave, who gave it, what kind of anesthetic, how much anesthetic, negative aspiration, no complications, ect.  

 

For more information and references:

Handbook of Local Anesthesia by Stanley F. Malamed 5th ed.  

 

Good Article with pictures: Pain Control:  The Options by Laura J Webb,CDA,RDH,MS,  www.rdhmag.com April 2010

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