Nerve Blocks of the Face

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  • Incision and drainage
  • Extensive wound care including debridement
  • Laceration repair including lacerations of the upper eyelid
  • Allergy to local anesthetics
  • Peripheral vascular, heart, and liver disease may increase the risk of severe complications.
  • Needle and syringe choice
    • 3-mL Luer-lock syringe with a 1½-inch, 25- to 27-gauge needle for intraoral or deep extraoral blocks
    • ½-inch, 25- or 27-gauge needle on a 3-mL syringe for the mental nerve block
  • Topical local anesthetic agents and cotton swabs (optional)
  • 1% or 2% lidocaine, with or without epinephrine
    • Do not use epinephrine in blocks for the infraorbital nerve.
  • Trigeminal nerve (fifth cranial nerve)
    • Ophthalmic nerve (V1 ; 1st branch of the trigeminal nerve
      • Five branches supply sensation to the forehead, cornea, upper eyelid, orbit structures, and frontal sinuses.
      • Leaves the cranium through the superior orbital fissure.
    • Maxillary nerve (V2 ; 2nd branch of the trigeminal nerve)
      • Has numerous branches that supply the midface, including the lower eyelid, upper lip, maxillary sinus, nasal cavity, soft and hard palate
    • Mandibular nerve (V3 ; 3rd branch of the trigeminal nerve)
      • Supplies the lower face and temporal region, including the lower jaw and lip
      • Inferior alveolar nerve
        • Divides into the incisive branch and the mental branch
        • Mental nerve exits the mental foramen to supply the chin and lower lip.
  • Bony landmarks
    • The supraorbital, infraorbital, and mental foramina are all in line just medial to the pupil.
    • The subtle supraorbital notch may be palpated along the superior orbital rim.
    • The infraorbital foramen is on the inferior border of the infraorbital ridge.
    • The mental foramen is located below the second premolar.

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  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Specific follow-up for the anesthetic procedure is not needed unless there is a complication.
  • Advise the patient to not eat solid foods and to avoid hot foods or aggressive wound care until the anesthesia has worn off.
  • Advise the patient to follow up if signs of infection develop at the site of infiltration.
  • Nerve injury is rare and most cases are transient and resolve completely.
  • Facial artery vasospasm
    • Severe epinephrine-induced tissue blanching or vasospasm may be reversed with local or intravascular injection of phentolamine.
  • Nerve injury
  • Intravascular injection
  • Hematoma
  • Infection
  • Systemic toxicity
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