Infiltration is carried out with the patient in the supine position, with the head in a slightly backward flexion position. The head is positioned in the midline.
The lower margin of the orbita is located, and subsequently the infra-orbital foramen is palpated and marked. The distance between the infra-orbital foramen and the side of the nose is about 2.5 cm (see figure).
The surrounding area is disinfected and covered with sterile drapes. A needle (22-G) is inserted perpendicularly (under ultrasound guidance), just medial to the infra-orbital foramen, until there is contact with bone. The location of the nerve is confirmed when the patient experiences paresthesia in the nose or upper lip. The needle is withdrawn slightly and bupivacaine 0.25% with 20 mg of methylprednisolone is injected (in 2 ml doses).
- The most serious complication of the injection is infection.
- Small subcutaneous bleedings may result in a temporary increase in pain after the injection.