Blockade of the periorbital nerves (supraorbital, supratrochlear, and infraorbital) is useful for surgical anesthesia of the face, treatment of painful facial conditions, and can provide diagnostic information for the possibility of neurolytic blocks and neuromodulatory techniques. The indications are summarized in Table 20-1.
TABLE 20-1.Indications for Periorbital Nerve Blocks |Favorite Table|Download (.pdf) TABLE 20-1.Indications for Periorbital Nerve Blocks
|Disease state ||Surgical anesthesia |
|Acute herpes zoster ||Facial lacerations |
|Trismus ||Acute pain emergencies |
|Atypical facial pain, migraines || |
|Cancer (head, neck, skin) || |
|Trigeminal neuralgia || |
|Cluster headaches || |
|Post-herpetic neuralgia Specific traumatic neuralgias of the periorbital nerves || |
The supraorbital and supratrochlear nerves are terminal branches of the ophthalmic division of the trigeminal nerve (V1).
The infraorbital nerve is a terminal branch of the maxillary division of the trigeminal nerve (V2).
V1 provides cutaneous innervation above the eye, forehead, and along the medial aspect of the nasal bridge.
V2 provides cutaneous innervation below the eye and the areas medial to the zygomatic arch to the nostril and the lateral forehead (Figure 20-1).
The supraorbital, supratrochlear, and infraorbital nerves lie along a vertical plane, which extends from the supraorbital notch to the corner of the mouth, bisecting the pupil.
The supraorbital notch is located above the pupil in the orbital rim, the supratrochlear groove is just medial to the supraorbital notch, while the infraorbital foramen is located 1 cm below the orbital rim, within the vertical plane.
The nerves emanate from these foramina respectively (Figure 20-2).
The supraorbital and infraorbital notches are relatively easy to palpate.
The supratrochlear nerve emanates from the supratrochlear notch, which lies at the intersection of the nasal bridge and the supraorbital ridge, medial to the supraorbital notch (Figure 20-3).
Trigeminal terminal branches.
Supraorbital and infraorbital nerves.
There are absolute and relative contraindications to performing periorbital nerve blocks, summarized below (Table 20-2):
TABLE 20-2.Absolute and Relative Contraindications to Periorbital Nerve Blocks |Favorite Table|Download (.pdf) TABLE 20-2.Absolute and Relative Contraindications to Periorbital Nerve Blocks
|Absolute ||Relative |
|Local infection ||Coagulopathy |
|Sepsis || |
Pt should be thoroughly evaluated prior to any interventional pain procedure and the risks/benefits explained.
Although a relative contraindication, coagulopathy does not preclude the safe performance of a periorbital nerve block.
Many patients who are anticoagulated suffer from painful conditions of the face and can benefit greatly from a periorbital nerve block.