. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. Fig. 254.—Injection in palatal mucous membrane at lateral incisor region. Syringe is heldlike penholder. (After Fischer.) THE ORGANS OF SPECIAL SENSE WITH DENTAL ANESTHESIA 603 Repeated punctures by the needle are to be avoided when possible,as two or more teeth can be injected by using a long needle andadvancing it in such a position that the area of inje
. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. Fig. 254.—Injection in palatal mucous membrane at lateral incisor region. Syringe is heldlike penholder. (After Fischer.) THE ORGANS OF SPECIAL SENSE WITH DENTAL ANESTHESIA 603 Repeated punctures by the needle are to be avoided when possible,as two or more teeth can be injected by using a long needle andadvancing it in such a position that the area of injection can be madeto embrace several teeth (Fig. 251). For injections upon the palatine surface the needle is made to entermore nearly in the axis of the tooth (Figs. 252, 254), inserted backfrom the gum margin, and advanced to a subperiosteal position overthe root apex. In dealing with the upper molars, instead of makingthe injection as above, an injection can be made into the posterior pala-tine canal (regional anesthesia), this injection sufficing for all threemolars, as follows: On the lateroposterior surface of the tuber maxillare of the superiormaxilla are seen a varying number of foramina, the openings of the. Fig. 255.—Position of needle for injection at maxillary tuberosity. (After Fischer.) posterior superior dental canals through which the sensory nerve-fila-ments pass to the three upper molars; before entering these canals thenerves run downward and forward for a short distance in the submucoustissue in close proximity to the parent trunk. (See Figs. 144-160.)To inject these nerves in this position the mouth is held half-open,the cheek drawn outward and upward, and the zygomatic processreached with the finger; the needle is entered high up in the mucousmembrane about over the second molar, with its point directed up-ward, backward, and inward, the syringe being held well away fromthe bone; the solution is injected as the needle is advanced, with the 604 LOCAL ANE
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