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
| Block | Anatomy | Guidance |
| 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 | ||
| Infraorbital | Branch 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/
