Head and Neck Block Anatomy

Use of regional anesthesia for head and neck surgery declined rapidly after general anesthesia and tracheal intubation became available and accepted. One reason for the decline is that small doses of local anesthetic can easily produce systemic toxicity. Nevertheless, in few other areas in the body can such small doses of local anesthetic provide such effective regional block. There are still circumstances in which head and neck block is useful. Many of these involve the diagnosis or treatment of pain syndromes. Also, many plastic surgical procedures on superficial structures can be managed easily with effective block of the nerves of the head and neck. One crucial aspect of head and neck block for anesthesiologists is expertise in airway anatomy and innervation. In some circumstances in an anesthetic practice, proper airway management, including airway blocks, can be lifesaving.

Sensory innervation of the face is provided by the trigeminal nerve. Three branches of the trigeminal—the ophthalmic, maxillary, and mandibular—provide innervation, as illustrated in Figure 18-1. The cutaneous innervation of the posterior head and neck is from the cervical nerves. The dorsal ramus of the second cervical nerve ends in the greater occipital nerve, which provides cutaneous innervation to the larger portion of the posterior scalp (see Fig. 18-1