1. Infraorbital
Nerve
Exits
infraorbital
foramen
4-‐7mm
below
the
inferior
orbital
rim
along
imaginary
medial
limbus
line.
Area
of
Anesthesia
Lateral
nose,
ipsilateral
cheek/upper
lip/lower
eyelid.
Approaches
1) Transcutaneous
nasolabial*
2) Perpendicular
transcutaneous
3) Intraoral
Injec5on
–
*Point
of
injecJon
Top
of
a
triangle
of
alar
rim
+
nasolabial
fold.
LeL
Index
finger
on
infraorbital
rim.
Advance
toward
foramen/bone.
Inject
1-‐2mL.
Mental
Nerve
Exits
foramen
below
apex
of
second
bicuspid
(+/-‐
6-‐10
mm).
Branching
variability
of
the
3
fascicles
means
transcutaneous
route
is
unreliable
Area
of
Anesthesia
Ipsilateral
lower
lip
down
to
the
labiomental
fold.
Approaches
1) Intraoral*
2) Perpendicular
transcutaneous
Injec5on
–
*Pull
lower
lip
and
buccal
soL
Jssues
laterally,
inject
at
the
2nd
mandibular
premolar
(bicuspid)
and
mucubuccal
fold,
advance
5-‐6mm,
inject
0.6-‐2mL.
Supraorbital
Nerve:
Exits
into
Supraorbital
notch;
palpable
at
the
supraorbital
rim
above
the
medial
limbus.
Supra+Infratrochlear
nerve;
found
under
medial
1cm
of
eyebrow
and
medial
orbital
wall,
respecJvely.
(This
approach
blocks
all
3
nerves).
Area
of
Anesthesia
1)
Forehead
skin
2)
Middle
50%
of
upper
eyelid.
3)
Frontoparietal
scalp
Approaches
1)
Transcutaneous
supraorbital
Injec5on
–
Inject
1-‐2mL
at
lateral
part
of
the
middle
third
of
eyebrow
at
the
supraorbital
notch.
Then
inject
1mL
along
the
rim
medially.
Finally,
inject
1mL
as
the
needle
touches
the
nasal
bones
medially.
Dorsal
Nasal
Nerve
Exits
at
the
lower
border
of
the
nasal
bone
6-‐10mm
laterally.
Area
of
Anesthesia
CarJlaginous
dorsum
and
Jp
of
the
nose.
Approaches
1)
Transcutaneous
Injec5on
–
Palpate
the
nasal
midline
and
feel
the
end
of
the
nasal
bones,
inject
1-‐2mL,
6-‐10mm
from
midline
Zygoma5cotemporal
Nerve
A
terminal
branch
of
V2’s
zygomaJc
nerve.
Exits
a
foramen
on
the
posterior
concave
surface
of
the
lateral
orbital
rim
1cm
below
level
of
the
canthus
Area
of
Anesthesia
Lateral,
Fan-‐shaped
quarter
circle.
Upper
limit
=
temporal
line
Lower
limit
=
canthal
line.
Approaches
1)
Transcutaneous
Injec5on
–
From
above
the
paJent,
inject
behind
the
lateral
orbital
rim.
inserJon
10-‐12mm
behind
and
just
below
zygomaJcofrontal
suture
(palpable).
Slide
needle
inferiorly
to
1cm
below
canthal
level
and
inject
while
withdrawing.
Zygoma5cofacial
Nerve
Second
terminal
of
zygomaJc
nerve.
Exits
foramen
on
anterior
surface
of
the
zygoma
just
lateral
to
the
intraorbital
rim.
Area
of
Anesthesia
Cheek
prominence
and
below;
isoceles
triangle
with
the
apex
on
the
anterior
mandible.
Approaches
1)
Transcutaneous
Always
done
aLer
zygomaJcotemporal
block.
Injec5on
–
Inject
anestheJc
into
a
dime-‐sized
area
just
lateral
to
the
juncJon
of
the
lateral
and
inferior
orbital
rim.
MK15
