INFRAORBITAL NERVE BLOCK TECHNIQUE | Tips for finding the infraorbital foramen

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.

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.

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.