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The greater palatine nerve block is useful for dental procedures involving the palatal soft tissues.  Minimum volumes of solution provide profound hard and soft tissue anesthesia.  Compared to the nasopalatine nerve block, the greater palatine nerve block is less traumatic as the tissues surrounding the greater palatine foramen are not as firmly adherent to bone and can accommodate the volume of solution deposited.

The greater palatine nerve is anesthetized with this block.  The areas that are anesthetized are the posterior portion of the hard palate and its overlying soft tissues, anteriorly as far as the first premolar and medially to the midline.

Proper technique:

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  1. 27-gauge short needle is recommended 

  2. Area of insertion: soft tissue slightly anterior to the greater palatine foramen  

  3. Target area: greater (anterior) palatine nerve 

  4. Landmarks

    • Greater palatine foramen ​

    • Junction of where horizontal and vertical palate meet 

  5. Path of insertion: advance the syringe from the opposite side of the mouth at a right angle to the target area

  6. Orientation of the bevel: toward the palatal soft tissues

Procedures:

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  1. Correct patient & clinician positioning

    • Right GP, right-handed clinician sit at 7:00 or 8:00 facing patient / left-handed clinician sit at 4:00 or 5:00 facing patient

    • Left GP, right-handed clinician sit at 11:00 facing in the same direction as the patient / left-handed clinician sit at 1:00 facing in the same direction as the patient

  2. Ask the patient, who is in a supine position, to do the following: ​

    • Open wide​

    • Extend their neck

    • Turn their head to the left or right (for improved visibility)

  3. Locate the greater palatine foramen

    • Place a cotton swab at the second molar at the junction of where the horizontal and vertical palate meet

    • Palpate by pressing firmly into the tissues until the swab "falls" into the depression created by the greater palatine foramen

    • The foramen is most frequently located distal to the maxillary second molar, but it may be located anterior or posterior to its usual position 

  4. Prepare tissue at the injection site

    • Dry with gauze or blow air with air/water syringe​

  5. Apply pressure anesthesia at the area of the foramen with the swab for at least 30 seconds (topical anesthetic is optional)

    • Swab should be in the left hand for the right-handed clinician / right hand for the left-handed clinician​

    • There should be blanching at the injection site

  6. Direct the syringe into the mouth from the opposite side with the needle approaching the injection site in the same direction as the swab

  7. Insert the needle anterior to the swab at a 45-degree angle until bone is contacted (about 1/4 needle or about 5mm)  

  8. Deposit anesthetic in small volumes throughout the procedure

    • Blanching spreads into adjacent tissues as the anesthetic (usually with a vasoconstrictor) is deposited​

  9. Continue to apply pressure anesthesia throughout the deposition of the anesthetic solution (blanching spreads as the vasoconstrictor decreases tissue perfusion)

  10. Aspirate in two planes

  11. If negative, slowly deposit (30 seconds minimum) not more than 0.45-0.6mL (1/4 to 1/3 of a cartridge) 

  12. Slowly withdraw needle and safely recap

  13. Wait 2-3 minutes before starting dental procedure​

G R E A T E R   P A L A T I N E   ( G P ) 

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