Velupillai Ilankovan - Local Flaps in Facial Reconstruction: A Defect Based Approach

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Part I
Foundations

Springer International Publishing Switzerland 2015

Velupillai Ilankovan , Madan Ethunandan and Tian Ee Seah Local Flaps in Facial Reconstruction 10.1007/978-3-319-08479-4_1

1. Local Anaesthesia

Velupillai Ilankovan 1, Madan Ethunandan 2 and Tian Ee Seah 3

(1)

Poole Hospital NHS Foundation Trust, Poole, Dorset, UK

(2)

Department of Oral and Maxillofacial Surgery, University Hospital Southampton NHS Trust Southampton General Hospital, Southampton, UK

(3)

Orange Aesthetics and Oral Maxillofacial Surgery, Singapore, Singapore

The cutaneous sensory nerve supply of the head and neck region is principally by the branches of the trigeminal nerve and cervical plexus, with smaller contributions from the other cranial nerves (Fig. ).

Fig. 1.1

Sensory nerve supply of the head and neck

Most of these nerves can be anaesthetised by nerve blocks, enabling surgical procedures to be carried out under local anaesthesia in addition to helping with postoperative analgesia.

Anaesthesia for Specific Areas

Forehead

Nerves

Supraorbital, Supratrochlear (Fig. )

Landmarks

• Supraorbital Nerve: Emerges from the supraorbital foramen along the vertical plane of the pupil
• Supratrochlear Nerve: Medial end of eyebrow, about 1.5 cm from midline

Technique

• Supraorbital Nerve : Prepare the skin using sterile technique. Request patient to look straightahead, palpate the supraorbital ridge and locate the supraorbital notch/foramen along the vertical plane of the pupil. Insert needle and raise a small skin wheal, advance needle 34 mm and deposit solution superior to the foramen in a supra-periosteal location.
• Supra trochlear Nerve : Insert needle at the medial end of the eyebrow, 1.5 cm from the midline and infiltrate anaesthetic in the subcutaneous tissues. Advance needle across the midline and deposit solution in a similar location to anaesthetise the contralateral nerve.

Area of Anaesthesia

Forehead up to the lateral canthus, anterior scalp up to the coronal plane

Fig. 1.2

Supraorbital, Supratrochlear nerve block

Temple

Nerves

Zygomaticotemporal Fig. , Auriculotemporal (Image: See Ear Anaesthesia)

Landmarks

Zygomatico temporal Nerve: Emerges from the zygomatioctemporal foramen and pierces the temporal fascia 2.5 cm above the medial end of the zygomatic arch

Technique

Prepare the skin using sterile technique. Insert needle 2.5 cm above the medial end of the zygomatic arch, lateral to the lateral orbital rim, and deposit solution into the subcutaneous tissues.

Area of Anaesthesia

Lateral forehead, medial temple

Fig. 1.3

Zygomaticotemporal, Zygomaticofacial nerve block

Landmarks

Auriculotemporal Nerve: Arises from the mandibular division of the trigeminal nerve, passes posterior to the neck of the condyle and runs superiorly crossing the root of zygomatic arch

Technique

Prepare the skin using sterile technique. Insert needle 2 cm above the tragus, just anterior to the superior attachment of the helix to the scalp, and deposit solution into the subcutaneous tissues.

Area of Anaesthesia

Lateral temple, tragus, superior helix

Caution: Avoid intravascular injection into superficial temporal vessels

Risk of bruising, haematoma

Paralysis temporal branch of facial nerve

Cheek

Nerves

Infraorbital (Fig. )

Landmarks

• Infraorbital Nerve: Emerges from the infraorbital foramen in the vertical plane of the pupil, 1.0 cm below the bony infraorbital rim

Technique

Prepare the skin using sterile technique. Ask patient to look straight ahead, palpate infraorbital rim and insert needle 1 cm below infraorbital rim along the vertical plane of the pupil. Deposit solution above periosteum, close to infraorbital foramen.

Area of Anaesthesia

Cheek, lower eyelid, lateral nose, upper lip

Fig. 1.4

Infrorbital nerve block

Landmark

Zygomaticofacial nerve emerges from the zygomaticofacial foramen, 2 cm below and lateral to the lateral canthus

Technique

Prepare the skin using sterile technique. Insert needle 2 cm below and lateral to the lateral canthus. Deposit solution above periosteum, close to the nerve.

Area of Anaesthesia

Skin overlying zygomatic prominence, lateral lower eyelid

External Nose

Nerves

Infraorbital, Infratrochlear, External nasal (Figs. )

Landmarks

Infra trochlear Nerve : Branch of the nasociliary nerve and emerges from the upper eyelid, 1 cm above the medial canthus

Technique

Prepare the skin using sterile technique. Insert needle 1 cm above medial canthus and infiltrate anaesthetic into the subcutaneous tissues.

Area of Anaesthesia

Upper nose, medial upper eyelid

Landmark

• External Nasal Nerve: Terminal branch of the ethmoid nerve, emerges from the lower margin of the nasal bone, courses on the surface of the upper lateral/alar cartilage, to the tip of the nose, 1 cm from the midline

Technique

Prepare the skin using sterile techniques. Insert needle 1 cm lateral to midline, at the junction of the nasal bone and the upper lateral cartilage, and deposit anaesthetic in the subcutaneous tissues.

Area of Anaesthesia

Mid, lower nose

Fig. 1.5

Local anaesthesia for external nose

Lips

Upper Lip

Nerves

Infraorbital ( See Fig . )

Lower Lip/Chin

Nerves

Mental nerve (Fig. )

Fig. 1.6

Mental nerve block

Landmark

• Mental Nerve : Emerges from the mental foramen, 2 cm above the lower border of mandible, along the vertical plane of pupil

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