INFRAORBITAL NERVE BLOCK TECHNIQUE | Tips for finding the infraorbital foramen
TLDRDr. Keith Ki Oral, a maxillofacial surgeon, presents an informative video on the infraorbital nerve block, also known as the anterior superior alveolar nerve block. This block is used for dental procedures involving multiple maxillary anterior teeth and their soft tissues, particularly when local infiltration is ineffective due to infection or dense bone. The video explains the procedure's benefits, including anesthesia for five teeth with only 0.9 to 1.2 ml of anesthetic, compared to 3 ml for separate infiltrations. It also covers the technique's contraindications, such as when only one or two teeth are involved, and the importance of proper needle insertion and patient positioning. Dr. Ki emphasizes the high success rate of the block and dispels common fears of eye injury, encouraging viewers to share and subscribe for more educational content.
Takeaways
- 🦷 The infraorbital nerve block (also known as the anterior superior alveolar nerve block) is used to anesthetize the soft tissues of the anterior portion of the face, including the lower eyelid, lateral aspect of the nose, and lips, but not the teeth.
- 💉 This block anesthetizes not only the infraorbital nerve but also the anterior superior alveolar nerve, middle superior alveolar nerve, and their branches, which are all branches of the maxillary nerve, the second branch of the trigeminal nerve.
- 🌟 The block is particularly useful for dental procedures involving more than two maxillary anterior teeth and their buccal soft tissues, especially when there is infection or inflammation that prevents the use of local infiltration.
- ⚠️ Contraindications include situations where only one or two teeth are to be treated, where local infiltration would be more appropriate.
- 🧵 A 27-gauge long needle is used, and the area of needle insertion is over the first premolar to reach the infraorbital foramen with the shortest route.
- 📍 Key landmarks for needle insertion include the mucobuccal fold, infraorbital notch, and the infraorbital foramen itself.
- 💧 The local anesthetic solution should be directed towards the infraorbital foramen, and the bevel of the needle should face the bone to avoid tearing the periosteum and causing patient discomfort.
- 🕒 The patient should be seated in a supine position with the neck slightly extended, and the tissues at the needle insertion site should be prepared with a sterile cause and topical anesthetic.
- 📏 The depth of needle penetration is typically 16 millimeters, which can vary depending on the patient's anatomy.
- 🕒 Aspirate before injecting and deposit 0.9 to 1.2 ml of solution over 30 to 40 seconds, applying firm pressure over the injection site for at least one minute to increase diffusion of the anesthetic.
- 🔋 Waiting for three to five minutes after the block is administered to ensure anesthesia has taken effect, using subjective signs like tingling and numbness, and objective signs like no response to an electric pulp test.
- 🌡 The advantage of this block is that it provides anesthesia to five teeth with a reduced volume of local anesthetic compared to separate local infiltrations, making it a simple and safe technique with a high success rate.
Q & A
What is the difference between an inferior alveolar nerve block and an infraorbital nerve block?
-An inferior alveolar nerve block is used to anesthetize the lower jaw, while an infraorbital nerve block is used to anesthetize the soft tissues of the anterior portion of the face and is not intended for teeth. The infraorbital nerve block also anesthetizes the anterior superior alveolar nerve, the middle superior alveolar nerve, and the infraorbital nerve along with its branches.
Why is it inaccurate to call the block for teeth the infraorbital nerve block?
-It is inaccurate because the infraorbital nerve itself does not supply the teeth. The block actually anesthetizes multiple nerves, including the anterior superior alveolar nerve and the middle superior alveolar nerve, which are responsible for the teeth's sensation.
Which nerves are anesthetized with the infraorbital nerve block and what areas do they supply?
-The infraorbital nerve block anesthetizes the infraorbital nerve, the anterior superior alveolar nerve, and the middle superior alveolar nerve. These nerves supply the soft tissues of the face, including the lower eyelid, lateral aspect of the nose, and lips, as well as certain maxillary teeth.
Why is the infraorbital nerve block useful in dental procedures?
-The infraorbital nerve block is useful when performing dental procedures on more than two maxillary anterior teeth and their buccal soft tissues, especially when there is infection or inflammation that prevents the use of local infiltration anesthesia, or when the cortical bone is too dense for local infiltration to be effective.
What are the contraindications for using an infraorbital nerve block?
-The block is not ideal when only one or two teeth are to be treated, as local infiltration is more suitable for such cases. Additionally, a bloodless field may be required in the area of treatment, which necessitates local infiltration for hemostasis.
What gauge needle is used for the infraorbital nerve block and where is it inserted?
-A 27 gauge long needle is used for the infraorbital nerve block, and it is inserted at the height of the mucobuccal fold over the first premolar.
How can the infraorbital foramen be located during the procedure?
-The infraorbital foramen can be located by palpating the infraorbital notch and then moving the finger downwards to feel an outward bulge, which is the lower border of the orbit and the roof of the infraorbital foramen. A concavity or depression felt further down indicates the foramen itself.
Why should the bevel of the needle face the bone during the infraorbital nerve block?
-The bevel of the needle should face the bone to ensure that when the needle contacts the bone, the bevel glides over it rather than the sharp point of the needle, which could tear the periosteum and cause pain to the patient.
What is the depth of needle penetration required for the infraorbital nerve block?
-The depth of needle penetration is typically 16 millimeters, which means that about half of the needle should be inserted into the tissues to reach the target depth.
How can the practitioner ensure the correct depth of needle insertion for different patients?
-By placing one finger on the infraorbital foramen and another finger intraorally on the injection site in the mucobuccal fold, the practitioner can estimate the distance between the two fingers and determine the necessary depth of penetration.
What are the signs that the infraorbital nerve block has been successful?
-Subjective signs include tingling and numbness of the lower eyelid, side of the nose, and upper lip. Objective signs can be determined using an electric pulp test or a freezing spray, with no response from the teeth indicating successful anesthesia. Absence of pain during treatment is also a key indicator.
What are the advantages of using the infraorbital nerve block?
-The infraorbital nerve block is a simple and safe technique that provides anesthesia to five teeth with just one injection, reducing the volume of local anesthetic needed. It has a high success rate and is effective when local infiltration is not suitable due to infection, inflammation, or dense cortical bone.
Outlines
😀 Introduction to Infraorbital Nerve Blocks
Dr. Keith Ki Oral, a maxillofacial surgeon, introduces a video on nerve blocks, specifically focusing on the infraorbital nerve block. Although the infraorbital nerve block is often confused with the anterior superior alveolar nerve block, it's important to note that the former anesthetizes not only the infraorbital nerve but also the anterior superior alveolar nerve, middle superior alveolar nerve, and their branches. These nerves are branches of the maxillary nerve, which is the second branch of the trigeminal nerve. The block is particularly useful for dental procedures involving multiple maxillary anterior teeth and their soft tissues, especially when local infiltration is not effective due to infection, inflammation, or dense cortical bone. Contraindications are also discussed, such as when only one or two teeth are involved, where local infiltration is preferred. The video proceeds to describe the procedure for the infraorbital nerve block using a 27 gauge long needle, with the insertion point being over the first premolar.
🔍 Locating and Administering the Infraorbital Nerve Block
The video explains the process of locating the infraorbital foramen by palpating the infraorbital notch and moving downward to feel the lower border of the orbit and the roof of the foramen. A depression, which is the foramen itself, is then identified. The patient is prepared with a topical anesthetic, and the tissues are made taut for needle insertion. The needle is inserted with the bevel facing the bone, parallel to the long axis of the tooth, and advanced until it contacts the bone at the roof of the infraorbital foramen. The depth of penetration is approximately 16 millimeters, and the local anesthetic is deposited slowly to minimize swelling. The video emphasizes the importance of keeping a finger over the foramen during injection to ensure the solution is directed properly and to increase diffusion into the foramen. After injection, a waiting period of three to five minutes is necessary before proceeding with the dental procedure.
📝 Signs of Successful Block and Advantages of the Technique
The video outlines the signs that indicate a successful infraorbital nerve block, which include subjective symptoms like tingling and numbness in the lower eyelid, side of the nose, and upper lip, and objective signs such as no response to an electric pulp test. The absence of pain during treatment is also a key indicator. The advantages of the infraorbital nerve block are highlighted, including its simplicity, safety, and the fact that it provides anesthesia to five teeth with only 0.9 to 1.2 ml of local anesthetic, as opposed to the 3 ml required for separate local infiltrations. The video acknowledges potential psychological barriers for inexperienced dentists but assures a high success rate with proper technique. Lastly, the video encourages viewers to share, subscribe, and provide feedback for improvement.
Mindmap
Keywords
💡Anesthesia
💡Infraorbital Nerve Block
💡Maxillary Nerve
💡Local Infiltration
💡Needle Insertion
💡Anatomical Landmarks
💡Muco-Buccal Fold
💡Anesthetic Solution
💡Electric Pulp Test
💡Hemostasis
💡Contraindications
Highlights
Dr. Keith Ki Oral, a maxillofacial surgeon, discusses the infraorbital nerve block technique, also known as the anterior superior alveolar nerve block.
The infraorbital nerve block anesthetizes not only the infraorbital nerve but also the anterior superior alveolar nerve, middle superior alveolar nerve, and their three branches.
This block is useful for dental procedures on more than two maxillary anterior teeth and their buccal soft tissues, especially when local infiltration is not effective due to infection or dense cortical bone.
A 27 gauge long needle is used for the block, with the insertion area being the height of the mucobuccal fold over the first premolar for the shortest route to the target area.
Landmarks for needle insertion include the mucobuccal fold, infraorbital notch, and the infraorbital foramen, which are palpated before the procedure.
The bevel of the needle should face the bone to prevent tearing of the periosteum and ensure a smooth glide over the bone.
The patient should be in a supine position with the neck slightly extended for comfort and accessibility.
A topical anesthetic is applied for at least one minute before the procedure to minimize discomfort.
The infraorbital foramen is located by palpating the infraorbital notch and feeling for a concavity or depression inferior to the notch.
The needle is inserted parallel to the long axis of the tooth and advanced slowly until bone is contacted, avoiding over-insertion into the orbit.
Local anesthetic is deposited in small amounts as the needle passes through soft tissues for patient comfort.
The needle penetration depth is typically 16 millimeters, but it can vary depending on the patient's anatomy.
Aspiration is performed in two planes before injecting 0.9 to 1.2 ml of solution to ensure safety.
Finger pressure over the injection site during and after the injection helps increase the diffusion of the local anesthetic solution into the infraorbital foramen.
A waiting period of three to five minutes is required after the block before starting the dental procedure.
Subjective signs like tingling and numbness, and objective signs like no response to an electric pulp test, indicate successful anesthesia.
The infraorbital nerve block is advantageous as it provides anesthesia to five teeth with only 0.9 to 1.2 ml of local anesthetic, reducing the overall volume required.
The block has a high success rate and is considered a simple and safe technique when performed correctly.
Potential disadvantages include difficulty in identifying anatomical landmarks and the initial fear of eye injury, which can be mitigated with experience and proper technique.
Transcripts
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