Background and indications: Maxillary nerve block is used primarily for the diagnosis of trigeminal neuralgia and for postoperative pain relief in children having cleft palate repairs. The block can also be used as the sole block for facial surgery in patients who are poor candidates for general surgery.

Anatomy: The maxillary nerve is the second division (V2) of cranial nerve V (trigeminal nerve). The nerve exits the base of the skull through the foramen rotundum and travels into the pterygopalatine fossa (Fig. 43.1). The nerve is anterior and deep to the lateral pterygoid plate. The nerve supplies sensory innervation to the skin of the face, including the cheeks, upper lip, and nasolabial folds, as well as sensory innervation to the maxillary sinuses, upper teeth, and the hard and soft palate.

Patient position:

Supine with the head turned away from the operator.

Transducer:

25- or 38-mm linear probe oscillating at 10 to 13 MHz.

Transducer orientation: Transverse oblique below the zygoma.

Needle: 22G, 5-cm needle with a blunt tip.

Local anesthetic: Ropivacaine 0.2%, bupivacaine 0.25%.

Technique: