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Nerve blocks on the face

Supraorbital and supratrochlear nerve

  • arise from ophthalmic division of V innervate the ipsilateral forehead and frontal scalp to the vertex
  • arises from supraorbital notch on orbital rim in midpupillary line
  • trochlear nerve 1 cm medial to supraorbital notch
  • both nerves can be blocked by entering just lateral to the supraorbital notch and injecting 1 – 2 mls of LA just toward the mid line.

Infraorbital nerve

  • largest branch of maxillary division of V
  • emerges from infraorbital foramen to supply the ipsilateral lower eyelid, nasal sidewall and ala, upper lip and medial cheek
  • infraorbital foramen just medial to the midpupillary line approx 0.7 – 1 cm below the infraorbital rim
  • can be blocked percutaneously or intraorally
  • intraoral route less painful especially with topical mucosal anesthetic
  • needle is advanced approx 1cm through the gingival buccal sulcus at the apex of canine fossa and 1 – 2 mls of LA injected just over the periosteum

Mental nerve

  • terminal branch of the mandibular division of V
  • emerges from the mental foramen located approx 2.5cm lateral to the midline, just medial to the mid-pupillary line and midway along the vertical height of the mandibular bone, approx 1cm above the inferior margin of the mandible
  • provides anesthesia to the ipsilateral chin and lower lip.
  • can be approached percutaneously or intraorally
  • intraoral route – 1 – 2 mls anesthetic injected into the inferior labial sulcus between the lower first and second premolars just over periosteum

Auriculotemporal nerve

  • another branch of the mandibular division of V
  • runs deep and posterior to the TMJ before it emerges superficially to travel with the superficial temporal artery
  • provides anesthesia to the ipsilateral anterior auricle lateral temple and temporal scalp
  • palpate the TMJ with the jaw open and inject 2 – 3 mls LA superior to the joint over the periosteum over the zygomatic arch

External nasal nerve

  • branch of the maxillary division of V
  • emerges from between the lower borders of the nasal bone and the upper lateral nasal cartilage
  • anesthesia to the skin of the ipsilateral nasal dorsum, nasal tip and columella can be obtained by injecting 1ml of LA bilaterally just off the midline after palpating for the junction between the mobile nasal cartilage and the firm nasal bones