Answer
The following are steps for the intraoral approach:
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Obtain informed consent.
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Apply cotton-tipped applicator soaked with topical anesthetic to the mucosa opposite the upper second bicuspid (premolar tooth) for 1 minute.
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To palpate the infraorbital foramen, have the patient look straight ahead and imagine a line drawn vertically (sagittally) from the pupil down toward the inferior border of the infraorbital ridge.
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Keep the palpating finger in place over the inferior border on the infraorbital rim for the remaining steps.
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Retract the cheek and introduce the needle into the mucosa opposite the upper second bicuspid approximately 0.5 cm from the buccal surface (see images below).
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Keep the needle parallel with the long axis of the second bicuspid until it is palpated near the foramen. (The approximate depth is 1.5-2.5 cm.) If the needle is extended too far superiorly and posteriorly, the orbit may be entered.
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Once the needle is positioned properly, aspirate to ensure that the needle is not within a vessel.
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Inject 2-3 mL of anesthetic solution adjacent to the foramen.
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Take care not to inject into the foramen (which may result in swelling of the lower eyelid) by keeping the palpating finger firmly on the inferior orbital rim.
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Infraorbital nerve.
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Area of anesthesia for infraorbital nerve block.
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Intraoral approach for infraorbital nerve block.
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Technique for extraoral infraorbital nerve block.
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Infraorbital nerve block, intraoral approach.