Provider Prepared's Weekly Pearl of Wound Wisdom # 34 Infraorbital how to
For anesthesia of the medial cheek, lateral nose, upper lip and lower eye lid, infraorbital nerve block is appropriate. We recommend the intra-oral approach for infraorbital nerve blocks.
Landmarks for the nerve block are: the second bicuspid, the pupil with a straight forward gaze and the inferior bony otrbit notch. The infraorbital foramen is located in the mid portion of the zygomatic arch, inline with these landmarks, and frequently can be palpated.
For an intraoral approach; insert a 27 or 25 gauge needle through the gum line, oriented in line with these landmarks at the second bicuspid, directed toward the infraorbital foramen. Keep a finger at the infraorbital foramen, when the pressure of the needle is palpated stop advancing the needle. If the patient develops paresthesia withdraw the needle a short distance until paresthesia resolves. Inject 1-2 mL of anesthestic in to this area.
Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.
Nathan Whittaker, MD
- Brandon Durfee