FIGURE 3.9 Infraorbital nerve and innervated area.

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.
In an anatomic study of skulls, infraorbital foramina were found to be 28.5 mm lateral to the midline and approximately 7 mm inferior to the inferior orbital rim and along a line drawn in a vertical (sagittal) orientation from the center of the patient’s pupil.³ A depression in the maxilla at the site of the foramen is difficult to palpate. To confirm the location, firm pressure directly over the foramen elicits the sensation of intense, dull pain, not found in adjacent areas.
At that site, 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

Headlamp or other light source (for intraoral approach)
3-mL syringe
30-gauge, 1/2-in. needle for transdermal and a 25-gauge 1½-in. needle for intraoral approach
1 mL of 1% lidocaine without epinephrine
One alcohol prep pad (for transdermal approach)
Sterile gauze pad

TECHNIQUE (TRANSDERMAL)

1. Prep the insertion site with alcohol pads.

2. Position the needle perpendicularly to the skin at the location over the maxilla identified above. The tip of the needle is directed toward the infraorbital foramen.

3. Provide skin distraction by pinching, stretching, and rubbing adjacent skin 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 infraorbital foramen.

6. Inject 0.5 to 1 mL of 1% lidocaine directly over the infraorbital foramen.

7. Following injection, withdraw the needle.

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