FIGURE 3.8 Supraorbital and supratrochlear nerves and innervated areas.
PATIENT POSITION
- Supine on the examination table with the head of the bed slightly elevated.
LANDMARKS
- With the patient supine on the examination table, the clinician stands lateral to the side of the face that is being injected.
- The supraorbital foramen is located superior (sagittal) to the center of the pupil as a subtle depression in the supraorbital ridge underneath the eyebrow.
- In an anatomic study of skulls, supraorbital foramina were found to be approximately 25 mm lateral to the midline, 30 mm medial to the temporal crest of the frontal bone, and 2 to 3 mm superior to the supraorbital rim. Additional exits for branches of the supraorbital nerve were present in 14% of skulls.3
- The supratrochlear nerve is located at the supraorbital ridge immediately vertical (sagittal) to the inner canthus of the eye. In most people, this is located at the medial aspect of the eyebrow.
- At sites located about 0.5 cm superior to the eyebrow at each nerve, press firmly on the skin with the retracted tip of a ballpoint pen. This indention represents the entry point for the needle.
ANESTHESIA
- Local anesthesia of the skin in this area with use of topical vapocoolant spray is not advised due to the close proximity to the eyes. However, skin distraction techniques may be employed.
EQUIPMENT
- 3-mL syringe
- 30-gauge, 1/2-in. needle
- 1 mL of 1% lidocaine without epinephrine
- One alcohol prep pad
- Sterile gauze pad
TECHNIQUE
1. Prep the insertion site with alcohol pads.
2. Position the needle at a 45-degree angle just above the eyebrow with the tip of the needle directed toward the supraorbital foramen.
3. Provide skin distraction by pinching, stretching, and rubbing adjacent skin over the eyebrow at the same time that the needle is being inserted into the skin.
4. Using the no-touch technique, quickly introduce the needle at the insertion site.
5. Advance the needle over the supraorbital foramen.
6. Inject 0.5 mL of 1% lidocaine directly over the supraorbital foramen.
7. Following injection, withdraw the needle.
8. Repeat the process for the supratrochlear nerve with the needle positioned over the supraorbital ridge immediately vertical (sagittal) to the inner canthus of the eye.
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