Interpretation of nerve blocks in 8 parts of the face in one article

1.

Scope of anesthesia: can anesthetize the side wall of the nose, lower eyelids, cheeks and upper lip (up to but usually not including the corners of the mouth)

2.

Range of anesthesia: The lower lip and upper jaw can be anesthetized, but the inferior branch of the mental nerve and the sensory branch of the mandibular hyoid muscle nerve run deep, so the lower jaw is usually not completely blocked

3.

Scope of anesthesia: It can anesthetize the middle half of the forehead, forehead skin and upper eyelid skin from the temporal line to the mesial line

4.

Anesthesia: Touch the distal end of the nasal bone with the index finger and thumb, and inject 1~2ml of local anesthetic 5~10mm outside the midline of the nose

Scope of anesthesia: outer wall of nasal cavity, wing of nose, nasal vestibule and tip of nose

5.

Anesthesia method: After palpating the zygomatic frontal suture, the puncture needle is inserted into the posterior orbital side under the surface mark about 5mm, and the local anesthetic is injected 10mm below the lateral canthus

Scope of anesthesia: the posterior area of ​​the lateral orbital wall from the upper lateral canthus to the hairline and temporal line
.

6.
Zygomatic nerve and zygomatic facial branch

The second distal branch of the zygomatic nerve is the zygomatic facial branch of the zygomatic nerve, which penetrates one or several small holes on the front surface of the zygomatic arch
.

Anesthesia: After palpating the intersection of the anterior orbit and the outer orbital rim, inject 2ml of local anesthetic at 1~2cm of the lateral surface of this point
.

Scope of anesthesia: anesthetize the tip of the buccal triangle and the lower edge of the anterior branch of the mandible
.

7.
Greater auricular nerve

The great auricular nerve originates from the back of the sternocleidomastoid muscle and continues to advance along its surface.

Anesthesia: The surface sign of the block is the intersection point of the sternocleidomastoid muscle 6.
5 cm below the external auditory meatus
.
A local anesthetic is injected into the superficial fascia of the muscle
.

The scope of anesthesia: the lower part of the ear, the skin behind the ear, and the area from the angle of the mandible to the tragus
.

8.
The mandibular branch of the trigeminal nerve

Anesthesia: Apply an epidural needle through the mandibular notch behind the pterygoid process
.
When the patient keeps opening and closing the mouth, the mandibular notch can be palpated about 2.
5 cm in front of the tragus
.
Inject a small amount of topical anesthetic before using a larger puncture needle
.
Then, use a 22 gauge epidural needle to pass through the anesthetized area and insert the needle perpendicular to the face until it hits the pterygoid process.
At this time, you should remember the depth of the needle (usually about 4cm, at this time, a plastic sliding ruler can be used) Mark)
.
Then withdraw the puncture needle almost completely, and re-inject the needle 1cm behind the previous needle insertion point until the needle depth is the same.
After withdrawal, 3~4ml local anesthetic can be injected to numb the cheeks
.

Scope of anesthesia: cheeks and most areas in front of the tragus
.

Facial nerve block

Apply 8 precisely positioned nerve blocks, the face can be completely anesthetized

The dot indicates the needle insertion point, and the arrow indicates the direction of needle insertion and infiltration

Source: Sherrell J.
Aston, Douglas S.
Steinbrech, Jennifer L.
Walden, "Aesthetic Plastic Surgery"