Maxillary Nerve

Blocking the maxillary nerve produces profound anesthesia in the hemimaxilla, cheek, and upper jaw. The maxillary nerve is the second division of the trigeminal

nerve and exits through the foramen rotundum. It crosses the pterygopalatine fossa and subsequently becomes the infraorbital nerve. The nerve can be approached by a lateral or anterior approach.

The lateral approach requires palpation of the sigmoid notch on the zygoma. With the patient's jaw relaxed, a long needle is inserted inferior to the sigmoid notch and directed anteriorly until the lateral pterygoid plate is felt. The needle is then withdrawn and reintroduced in a more anterior and superior direction, anterior to the pterygoid plate and into the sphenomaxillary fossa (Fig. 7). Parasthesias will usually be encountered and 2 to 3 ml of 1% lidocaine are injected.

Figure 8 Anterior approach to the maxillary nerve block.

The anterior approach requires locating the anterior border of the coronoid process and the inferior margin of the zygoma. A long needle is inserted perpendicular to the skin until the maxilla is felt. The needle is then withdrawn and directed superior and posterior to enter the sphenomaxillary fossa (Fig. 8). There are no specific complications of this technique. If air is encountered during aspiration, it usually means that the pharyngeal space has been entered and the needle must be repositioned.


Sensory innervation of the nose is derived principally from the infratrochlear, infraorbital, nasopalatine, and external nasal nerves. Branches of the anterior ethmoidal and sphenopalatine ganglion supply the anterior aspect of the nose. Intranasal blocks are usually obtained by placement of intranasal topical cocaine in the region of the middle meatus, sphenopalatine ganglion, and the dorsal root of the nose. An external block can be performed with the injection of local anesthetic in the manner of a rhinoplasty block, with care taken to anesthetize the infratrochlear, infraorbital, and external nasal nerves (Fig. 9). There are no specific complications of this technique, but care should be taken to use cocaine appropriately.

The auriculotemporal nerve, mastoid branch of the occipital nerve, and the occipital nerve provide the sensory innervation to the external ear (Fig. 10). These nerves are readily anesthetized using a circular field block technique. There are no unique complications of this technique.

Infraorbital Nerve
Figure 9 Sensory innervation of the nose: infratrochlear nerve, external nasal nerve, and infraorbital nerve.
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