Pediatric emergency medicine trisk 3305 3305
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or long-term cosmesis or complications such as infection or wound dehiscence.
Additionally, caregivers had a significantly higher future preference for the
absorbable sutures. Tissue adhesives such as 2-octylcyanoacrylate have also
demonstrated similar cosmesis, less pain, and shorter procedure times when
compared to sutures for simple lacerations, but may have a slightly increased risk
of wound dehiscence.
Regional Nerve Blocks
CLINICAL PEARLS AND PITFALLS
Important areas for regional nerve blocks on the face include the
medial third of the eyebrow (supraorbital nerve), the infraorbital
foramen (infraorbital nerve), and 2 to 3 cm above the inferior border of
mandible (mental nerve).
Clinical Considerations
Local or regional anesthesia may be used to aid in the suturing of facial
lacerations in children. Regional anesthesia has the distinct advantage of allowing
the physician to perform a painless procedure, without distorting the anatomic
structures under repair. In addition, regional blocks, in general, require fewer
anesthetics (see Chapter 130 Procedures ).
The supraorbital nerve exits the supraorbital rim in the medial third of the
eyebrow approximately 2 to 3 cm from the facial midline. Local infiltration in
this region can effectively provide anesthesia to the ipsilateral hemiforehead. The
infraorbital nerve exits through the infraorbital foramen, approximately 5 mm
inferior to the infraorbital rim. Effective block of this nerve can provide
anesthesia to the ipsilateral medial cheek and upper lip. Anesthesia of the lower
lip and chin may be achieved by infiltration of the ipsilateral mental (infraoral)
nerve. This nerve exists approximately 2 to 3 cm superior to the inferior border of
the mandible. The supraorbital and infraorbital nerves, as well as the mental
nerve, exit the facial skeleton from foramen, which are in-line with the first
premolar tooth.
Guidelines for Subspecialty Consultation
CLINICAL PEARLS AND PITFALLS
