LA Written Competency Exam
What is the largest cranial nerve?
trigeminal nerve
What are the divisions of the trigeminal nerve and where do they exit?
V1 - ophthalmic -----> superior orbital fissure
V2 - maxillary-------> foramen rotundum
V3 - mandibular-----> foramen ovale
What do the nerves of the opthalmatic division innervate?
structures w/in orbit of the eye, ethmoid and frontal sinuses, skin of the forehead, upper
eyelid, nose
What do the nerves of the maxillary division innervate?
sensory from upper teeth, upper gum, upper lip, palate, and skin of face
What do the nerves of the mandibular division innervate?
-sensory from scalp, skin of jaw, lower teeth, lower gum, and lower lip
-motor to muscles of mastication and muscles in floor of mouth
ASA
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
Needle Gauge:
Area anesthetized: MX central, lateral, cuspid, periosteum, and buccal soft tissue to
midline
Landmarks: canine fossa between lateral and canine
Insertion: height of muccobuccal fold 25 degrees medially to root of canine
Depth: 4-6 mm, 1/4"
Volume: 1/2-2/3 cartridge
Needle gauge: 25 or 27 short
MSA
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
Needle Gauge:
ABSENT IN LARGE % OF POPULATION
Area anesthetized: MX premolars, MB root of MX 1st molar, periosteum, buccal tissue
Landmarks: zygomatic process, MX premolars
Insertion: height of muccobuccal fold over MX 2nd premolar
Depth: 4-10mm, 1/4-1/2" or 5-8 mm
Volume: 1/2-2/3 cartridge
Needle Gauge: 25 or 27 short
PSA
Area anesthetized:
,Landmarks:
Insertion:
Depth:
Volume:
Needle Gauge:
Area anesthetized: 3rd, 2nd and 1st MX molars (EXCEPT MB root of 1st molar),
periosteum, B tissue
Landmarks: zygomatic eminence MX tuberosity, ala of nose, corner of mouth
Insertion: height of muccobuccal fold in concavity distal to zygomatic buttress, above
2nd molar, 45 degrees angle superior to occlusal plane. DB root of 2nd molar
Depth: 16 mm, 3/4" (3-4 mm from hub)
Volume: 1/2- 1 cartridge
Needle Gauge: 25 or 27 short
GP - Greater Palatine
Area anesthetized:
Landmarks:
Insertion:
Depth:
Deposition/Target site:
Volume:
Needle Gauge:
Area anesthetized: no teeth. hard palate and lingual tissue posterior to 1st premolar
and medial to midline
Landmarks: vertical/horizontal process of MX and palatine bones, 2nd or 3rd molar
apices
Insertion: greater palatine foramen at junction of MX alveolar process and palatine
bone. Lingual to 2nd molar.
Depth: approx. 4-6 mm, 1/8-1-4"
Target site: slightly anterior to greater palatine foramen
Volume: 1/4-1/3 cartridge
Needle Gauge: 27 or 30 short or extra short
Nasopalatine
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
deposition/target site:
Needle Gauge:
Area anesthetized: no teeth. anterior 1/3 of hard palate, lingual tissues from cuspid to
cuspid
Landmarks: MX centrals, incisive papilla
Insertion: lateral to incisive papilla at widest aspect. 45 degrees angle to anterior palate
Depth: 3-5 mm, 1-8-1/4"
Volume: 1/8-1/4 cartridge (1 stopper full)
deposition/target site: Incisive foramen beneath papilla
, *one injection will anesthetize both right and left NP nerves
Needle Gauge: 27 or 30 short or extra short
Inferior alveolar
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
Deposition/target site:
Needle Gauge:
Area anesthetized: MD teeth to midline, buccal tissue only from premolars to midline
(no molar tissue)
Landmarks: coronoid notch, pterygomandibular raphe, occlusal plane of MD premolar
teeth and commisure of contra lateral side
Insertion: medial to internal oblique ridge, lateral to pterygomandibular raphe, at or
above height of coronoid notch
Depth: 20-25 mm (2/3-3/4" of needle)
Volume: 3/4-1 cartridge
deposition/target site: Directly above mandibular foramen.
Needle Gauge: 25 or 27 long
Lingual
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
Deposition/target site:
Needle Gauge:
Area anesthetized: no teeth. lingual gingiva of MD quad, anterior 2/3 of tongue, floor of
mouth
Landmarks: coronoid notch, pterygomandibular raphe, occlusal plane of MD premolar
teeth and commisure of contra lateral side
Insertion: medial to internal oblique ridge, lateral to pterygomandibular raphe, at or
above height of coronoid notch
Depth: 1/2 of IA, 10-13 mm
Volume: 1/8 of cartridge (1 stopper full)
deposition/target site: Half the distance to mandibular foramen at lingual nerve.
Needle Gauge: 25 or 27 long
Buccal
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
Needle Gauge:
Area anesthetized: no teeth! soft tissues and periosteum buccal to MD molars
What is the largest cranial nerve?
trigeminal nerve
What are the divisions of the trigeminal nerve and where do they exit?
V1 - ophthalmic -----> superior orbital fissure
V2 - maxillary-------> foramen rotundum
V3 - mandibular-----> foramen ovale
What do the nerves of the opthalmatic division innervate?
structures w/in orbit of the eye, ethmoid and frontal sinuses, skin of the forehead, upper
eyelid, nose
What do the nerves of the maxillary division innervate?
sensory from upper teeth, upper gum, upper lip, palate, and skin of face
What do the nerves of the mandibular division innervate?
-sensory from scalp, skin of jaw, lower teeth, lower gum, and lower lip
-motor to muscles of mastication and muscles in floor of mouth
ASA
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
Needle Gauge:
Area anesthetized: MX central, lateral, cuspid, periosteum, and buccal soft tissue to
midline
Landmarks: canine fossa between lateral and canine
Insertion: height of muccobuccal fold 25 degrees medially to root of canine
Depth: 4-6 mm, 1/4"
Volume: 1/2-2/3 cartridge
Needle gauge: 25 or 27 short
MSA
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
Needle Gauge:
ABSENT IN LARGE % OF POPULATION
Area anesthetized: MX premolars, MB root of MX 1st molar, periosteum, buccal tissue
Landmarks: zygomatic process, MX premolars
Insertion: height of muccobuccal fold over MX 2nd premolar
Depth: 4-10mm, 1/4-1/2" or 5-8 mm
Volume: 1/2-2/3 cartridge
Needle Gauge: 25 or 27 short
PSA
Area anesthetized:
,Landmarks:
Insertion:
Depth:
Volume:
Needle Gauge:
Area anesthetized: 3rd, 2nd and 1st MX molars (EXCEPT MB root of 1st molar),
periosteum, B tissue
Landmarks: zygomatic eminence MX tuberosity, ala of nose, corner of mouth
Insertion: height of muccobuccal fold in concavity distal to zygomatic buttress, above
2nd molar, 45 degrees angle superior to occlusal plane. DB root of 2nd molar
Depth: 16 mm, 3/4" (3-4 mm from hub)
Volume: 1/2- 1 cartridge
Needle Gauge: 25 or 27 short
GP - Greater Palatine
Area anesthetized:
Landmarks:
Insertion:
Depth:
Deposition/Target site:
Volume:
Needle Gauge:
Area anesthetized: no teeth. hard palate and lingual tissue posterior to 1st premolar
and medial to midline
Landmarks: vertical/horizontal process of MX and palatine bones, 2nd or 3rd molar
apices
Insertion: greater palatine foramen at junction of MX alveolar process and palatine
bone. Lingual to 2nd molar.
Depth: approx. 4-6 mm, 1/8-1-4"
Target site: slightly anterior to greater palatine foramen
Volume: 1/4-1/3 cartridge
Needle Gauge: 27 or 30 short or extra short
Nasopalatine
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
deposition/target site:
Needle Gauge:
Area anesthetized: no teeth. anterior 1/3 of hard palate, lingual tissues from cuspid to
cuspid
Landmarks: MX centrals, incisive papilla
Insertion: lateral to incisive papilla at widest aspect. 45 degrees angle to anterior palate
Depth: 3-5 mm, 1-8-1/4"
Volume: 1/8-1/4 cartridge (1 stopper full)
deposition/target site: Incisive foramen beneath papilla
, *one injection will anesthetize both right and left NP nerves
Needle Gauge: 27 or 30 short or extra short
Inferior alveolar
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
Deposition/target site:
Needle Gauge:
Area anesthetized: MD teeth to midline, buccal tissue only from premolars to midline
(no molar tissue)
Landmarks: coronoid notch, pterygomandibular raphe, occlusal plane of MD premolar
teeth and commisure of contra lateral side
Insertion: medial to internal oblique ridge, lateral to pterygomandibular raphe, at or
above height of coronoid notch
Depth: 20-25 mm (2/3-3/4" of needle)
Volume: 3/4-1 cartridge
deposition/target site: Directly above mandibular foramen.
Needle Gauge: 25 or 27 long
Lingual
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
Deposition/target site:
Needle Gauge:
Area anesthetized: no teeth. lingual gingiva of MD quad, anterior 2/3 of tongue, floor of
mouth
Landmarks: coronoid notch, pterygomandibular raphe, occlusal plane of MD premolar
teeth and commisure of contra lateral side
Insertion: medial to internal oblique ridge, lateral to pterygomandibular raphe, at or
above height of coronoid notch
Depth: 1/2 of IA, 10-13 mm
Volume: 1/8 of cartridge (1 stopper full)
deposition/target site: Half the distance to mandibular foramen at lingual nerve.
Needle Gauge: 25 or 27 long
Buccal
Area anesthetized:
Landmarks:
Insertion:
Depth:
Volume:
Needle Gauge:
Area anesthetized: no teeth! soft tissues and periosteum buccal to MD molars
