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Chapter 35. Oral and Maxillofacial Regional Anesthesia

The maxillary division (V2) of the trigeminal nerve exits the cranium through the:

A. Foramen ovale

B. Incisive foramen

C. Foramen rotundum

D. Infraorbital foramen

C is correct. The maxillary division (V2) of the trigeminal nerve leaves the cranium through the foramen rotundum, located in the greater wing of the sphenoid bone.

A is incorrect. The sensory root of the mandibular branch (V3) of the trigeminal nerve passes through the foramen ovale almost immediately after coming off the trigeminal ganglion.

B is incorrect. The nasopalatine nerve enters the oral cavity through the incisive foramen to supply the palatal mucosa of the premaxilla.

D is incorrect. The infraorbital nerve divides into three terminal branches after emerging through the infraorbital foramen onto the face.

Hematoma formation due to accidental puncture of the maxillary artery is a possible complication of which of the following blocks?

A. Posterior superior alveolar nerve block

B. Anterior superior alveolar (infraorbital) nerve block

C. Greater palatine nerve block

D. Nasopalatine nerve block

A is correct. The posterior superior alveolar nerve block is used to achieve anesthesia of the maxillary molar teeth up to the first molar, with the exception of the mesiobuccal root in some cases. A possible complication of the posterior superior alveolar nerve block is hematoma formation from injection of anesthetic into the pterygoid plexus of veins or from accidental puncture of the maxillary artery necessitating aspiration before injection.

B is incorrect. The anterior superior alveolar nerve block is a technique for achieving anesthesia of the maxillary central and lateral incisors and canine as well as the surrounding soft tissue on the buccal aspect. Accidental maxillary artery puncture is not a complication.

C is incorrect. The greater palatine nerve block targets the palatal aspect of the maxillary premolar and molar dentition.

D is incorrect. For the nasopalatine nerve block, local anesthetic is deposited in the area of the incisive foramen to anesthetize the nasopalatine nerves bilaterally.

For the nasopalatine nerve block, the injection site is located:

A. In the area of the incisive foramen, directly lateral to the incisive papillae

B. At the height of the mucobuccal fold just distal to the maxillary second molar

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