Infraorbital nerve block (intraoral approach)

The infraorbital nerve block anesthetizes the upper lip, lateral nose, lower eyelid, and medial cheek as shown in A. To perform, locate the infraorbital foramen with the middle finger and lift the upper lip with the index finger and thumb as shown in B. Numb the upper gum line near the second bicuspid using topical anesthetic (eg, 2 percent viscous lidocaine on a Q-tip). Insert a small needle (gauge 25 or 27) through the gum line and at the second bicuspid as shown until the needle is palpated at the infraorbital foramen (approximately 2 cm in the adolescent or adult). If the patient reports paresthesias, withdraw the needle until paresthesias resolve. Inject one to two mL of buffered lidocaine 1 percent with epinephrine. Allow 5-10 minutes for complete anesthesia to occur.