How Do You Perform a Maxillary Nerve Block?

A maxillary nerve block is administered to nerves near the upper bone plate of the jaw to numb the face.

A maxillary nerve block is a procedure that provides regional anesthesia to parts of the nose, upper jaw, cheek, and mouth. Maxilla is the plate of bone in the front of the face from below the eyes up to the top of the upper teeth.

The maxillary nerve block procedure involves administration of a local anesthetic adjacent to the maxillary nerve. The anesthetic blocks transmission of pain signals that pass through the nerve from the face to the brain.

The maxillary nerve is a nerve of sensation. The maxillary nerve carries sensory information to the brain as it is received through four major branches:

• Middle meningeal nerve: Supplies sensation to a part of the brain’s membrane (dura mater).
• Zygomatic nerves: Responsible for sensation in the cheek, lower eyelid and tear gland.
• Pterygopalatine (sphenopalatine) nerves: Responsible for sensation in the nasal cavity, nostrils, soft and hard palate, and pharynx.
• Posterior superior alveolar nerves: Responsible for the sensation in the gums, posterior cheek, nasal floor, and upper teeth, except for the three molars.

A maxillary nerve block is mainly performed for treatment procedures such as:

• Dental procedures involving multiple teeth and surrounding areas
• Treatment of large canine tooth abscesses
• Inability to administer local blocks due to infection or abscess
• Major surgery involving the maxilla for cancer or trauma
• Repair of the congenital cleft palate in children
• Post-operative pain relief after maxillary surgeries
• Chronic facial pain that does not respond to medication
• Some forms of trigeminal neuralgia

A maxillary nerve block is avoided with:

• Infection in the injection site
• Bleeding disorders
• Allergy to local anesthetics

A maxillary nerve block may be administered as an outpatient procedure, or along with general anesthesia for major facial surgeries. The duration of hospitalization and recovery will depend on the type of surgical procedure performed.

Anesthesia

The doctor may use one of the following three anesthetic agents:

• Lidocaine
• Bupivacaine
• Mepivacaine

Preparation

No special preparation is normally required for a maxillary nerve block, except if it accompanies general anesthesia.

• The patient lies flat or in a semi-reclining position.
• The doctor may administer mild sedation.
• The patient’s heart rate, blood pressure and oxygen levels are monitored.

Procedure

The doctor may give the maxillary nerve block injection using one of the following three techniques:

High tuberosity approach

The doctor

• Retracts the cheek with a tongue depressor, while the patient keeps their mouth open.
• Inserts the needle near the gum of the second upper molar, parallel to the cheek.
• Advances the needle into the depression under the cheek bone (pterygopalatine fossa).
• Slowly injects the anesthetic and withdraws the needle.

Greater palatine canal approach

The doctor

• Positions the needle in the palate next to the second upper molar, while the patient keeps their mouth wide open.
• Inserts the needle till it reaches the bone and injects a small quantity of anesthetic.
• After a five-minute wait for the anesthesia to take effect, advances the needle into the hole (foramen) through which the maxillary nerve branch emerges into the palate.
• Advances the needle through the foramen into the greater palatine canal.
• Slowly injects the anesthetic and withdraws the needle.

Coronoid approach

The doctor

• Uses imaging guidance for this approach.
• Sterilizes the skin on the cheek in front of the ear, while the patient keeps their mouth in a neutral position.
• Inserts the needle perpendicular to the skin.
• Advances the needle in the notch (coronoid process) under the cheekbone, slightly upward.
• Slowly injects the anesthetic and withdraws the needle.

A maxillary nerve block is a relatively safe procedure with minimal risks. Complications include:

• Needle-track infection
• Hematoma behind the eye 
• Nerve injury resulting in persistent tingling or numbness
• Block of other nearby nerves resulting in temporary
  • Blindness
  • Double vision
• Injury to a blood vessel and hemorrhaging
• Allergic reaction to the medication
• Systemic toxic response from the local anesthetic injected into a blood vessel causing
  • Anxiety
  • Numbness
  • Dizziness
  • Weakness
  • Tremors
• Cardiovascular and central nervous system collapse, due to local anesthetic systemic toxicity (very rare)