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Facial Blocks with Dr. Erica Westlake, PGY2

Why use facial blocks?

  • Indications include: laceration repair, acute migraine headaches, zoster outbreaks
  • Improved cosmetic healing with regional block compared to infiltrative anesthesia 
  • Block provides longer duration of anesthesia compared to infiltrative anesthesia 

How do you perform facial blocks?

  • The supraorbital, infraorbital and mental foramen should align with a line drawn vertically through the ipsilateral centered pupil 
  • Assess neurovascular status prior to anesthesia especially with trauma 
  • Massage area of anesthesia to assist with distribution 
  • Complications include: bleeding, hematoma, infection, incomplete anesthesia, vascular puncture, nerve injury, systemic local anesthetic toxicity, ocular injury
BlockAnatomyGuidance
Supraorbital 








Branch of frontal nerve which continues superiorly 


Branch of frontal nerve which continues medially 
-Supraorbital foramen is 2 cm laterally from nasal aspect of orbital rim-Block both the supraorbital and supratrochlear nerve by directing the needle first cephalad and then medially toward nasal spine
Supratrochlear
InfraorbitalBranch of maxillary nerve which continues medially and caudally -Infraorbital foramen is below the orbital rim at intersection of pupil and nasal alae
-Intraoral approach: inject into the buccal mucosa at canine and direct upward and outward
-Extraoral approach: laterally approach foramen until bone is hit, inject local anesthetic 
Mental Branch of mandibular (alveolar) nerve which continues medially -Mental foramen in line with premolar tooth
-Intraoral approach: retract lower lip and insert needle into mucosa of first premolar tooth, inject down and outward 
Extraoral approach: approach foramen laterally
 

References

Gibbs MA, Wu T. Local and Regional Anesthesia. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill; 2020. 

Davies T, Karanovic S, Shergill B. Essential regional nerve blocks for the dermatologist: part 1. Clin Exp Dermatol. 2014 Oct;39(7):777-84. doi: 10.1111/ced.12427. PMID: 25214404. https://onlinelibrary.wiley.com/doi/pdf/10.1111/ced.12427 

Sola, C., Dadure, C. D., Choquet, O., & Capdevila, X. (2022, April 26). Nerve blocks of the face. NYSORA. https://www.nysora.com/techniques/head-and-neck-blocks/nerve-blocks-face/   

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