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Face Regional Block

Aka: Face Regional Block, Regional Anesthesia for the Central Face, Infraorbital Nerve Block
  1. Indication
    1. Regional Anesthesia for upper lip, cheeks, nose (part)
  2. Physiology: Landmarks for Infraorbital Nerve (V2 portion of Trigeminal Nerve)
    1. Exits skull at infraorbital foramen along the infraoribtal ridge
    2. Centered below midline of orbit, in line with mid-pupil on forward gaze
  3. Technique: Infraorbital Nerve Block (extraoral approach)
    1. Locate infraorbital foramen as above
    2. Insert needle
      1. Examiner places one finger over the infraorbital ridge
      2. Insert inferior to foramen by 1 cm (slightly medial)
      3. Direct needle toward supraorbital foramen and superolaterally
      4. Avoid approaching orbit
    3. Infiltrate at infraorbital foramen
      1. Aspirate first to confirm not in facial artery or facial vein
      2. Use 2-4 cc of 1% Lidocaine
      3. Inject just above bone level
      4. Redirect needle if Paresthesias or sharp pain
  4. Technique: Infraorbital Nerve Block (intraoral approach)
    1. Consider applying topical anesthetic to the mucosa at the injection site
    2. Examiner positions non-dominant hand
      1. Examiner places middle finger on infraorbital ridge at infraorbital foramen
      2. Examiner grasps the patients lip between their thumb and index finger retracting the lip upward and outward
    3. Insert needle
      1. In line with the second premolar, directed toward the infraorbital foramen
      2. Advance the needle toward the infraorbital foramen
      3. Exercise caution
        1. Do not go beyond the bony orbit
        2. Avoid entering the infraorbital foramen
    4. Infiltrate the infraorbital foramen
      1. Use 1-3 ml of Lidocaine 1%
    5. Advantages
      1. Intraoral approach delivered anesthetic lasts twice as long as extraoral delivered anesthetic
  5. References
    1. Moy in Pfenninger (1994) Procedures, p. 145-55
    2. Salam (2004) Am Fam Physician 69(3):585-90 [PubMed]
    3. Latham (2014) Am Fam Physician 89(12): 956-62 [PubMed]

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