2. ANATOMY
➤ Head innervated by cranial and spinal nerves.
➤ Trigeminal CN 5, sensation to head and neck.
➤ Ophthalmic nerve/supraorbital nerve V1
➤ Maxillary nerve/Infraorbital nerve V2.
➤ Mandibular nerve/ Mental nerve V3.
3.
4. ANATOMY
➤ Ophthalmic supraorbital foremen
➤ Sensation to eyeball, upper scalp, forehead.
➤ Maxillary infraorbital foramen— sensation to mid face and
eye.
➤ Mandibular mental foramen, sensation to lower 3 rd face,
muscles of mastication.
5.
6. LOCAL ANESTHETIC.
➤ Topical/EMLA, 2.5% lidocaine +2.5% prilocaine.
➤ Local occlusive dressing, wait for 60 minutes.
➤ Careful in large areas, back, chest and legs.
➤ 2 deaths in US, hair removal back and legs.
➤ 3-5 mm depth, duration 1-2 hrs.
➤ Toxicity, 1-2 gm/10cm2 skin.
➤ Adult max 2000cm2, children max 100cm2.
7. LOCAL ANESTHETIC
➤ To use epinephrine or not to use epinephrine.
➤ Why use epinephrine
➤ Decrease bleeding.
➤ Prolonged anesthesia, x2 duration of lidocaine.
➤ Decreased systemic effects due to localization.
➤ Careful in elderly and cardiac patients.
➤ Intravascular injection
➤ 30-60 sec increase heart rate by 20% for 30-60 seconds.
9. INJECTION TECHNIQUES
➤ Minimizing pain.
➤ Inject small amounts first then come back. Give the drug time
to take effect.
➤ Use the smallest needle possible. 30G.
➤ Inject very slowly, rate of nerve firing proportional to rate of
tissue expansion.
➤ Distraction, rubbing, tugging of skin and talking.
10.
11. INJECTION TECHNIQUES
➤ Massage anesthetic in increase effectiveness, decrease
distortion.
➤ Avoiding complications.
➤ Keeps needle moving.
➤ Stop if sharp, electric shooting pain or if patient complains of
unbearable pain.
➤ Stop if unbearable resistance. If it doesn’t feel right don’t do
it.
12. NERVE BLOCK FOR FACIAL ANESTHETIC.
➤ Infraorbital block.
➤ External approach. Feel for Infraorbital foramen. 0.5 cc -1cc
per site is adequate.
➤ Good for teartrough injection.
➤ Intramural/dental block, direct towards Infraorbital foramen.
Canine.
➤ Fanning.
➤ May need to supplement at filtering for upper lip.
➤ 0.5-1cc per site is adequate.
➤ Good for nasolabial folds and upper lip.
13. NERVE BLOCK FOR FACIAL ANESTHESIA.
➤ Mental block.
➤ External approach, locate mental foramen. 0.5-1cc per site is
adequate.
➤ Intraoral approach. Inject between first and second premolar.
0.5-1cc per site adequate, fanning.
➤ Good for lower lip and chin.
14.
15.
16.
17.
18. CONCLUSION
➤ Know your anatomy.
➤ Know your drugs.
➤ Don’t be afraid.
➤ Patient will come back if they are comfortable.
➤ Questions?
