Anesthesia for Rhinoplasty

Abstract

Nasal innervation is performed through either the mucosal (internal) or skin (external) part of the nose. Externally, the nose is innervated with the ophthalmic and maxillary nerves and the nerves to the superior tip are furnished through the infratrochlear, supratrochlear, and external nasal branch of the anterior ethmoid nerves. The infraorbital nerve furnishes both the inferior and lateral nose regions, which extend to eyelids. The naso-sinus cavity can be categorized into three parts: (1) lateral walls, (2) nasal septum, and (3) the cribriform plate. The anterior and posterior ethmoid nerves provide nerve endings to the lateral nasal wall and the posterior nasal cavity is innervated by the sphenopalatine ganglion. The septum is furnished with nerve endings from the anterior and posterior ethmoid nerves and the sphenopalatine ganglion, while the olfactory nerve supplies the cribriform plate (cranial nerve I). Nasal anesthetic block can be acquired using topical and infiltration methods. Topical ointments can be used as an aerosol or swabbed in the nasal cavity using a cotton-tipped applicator. These methods numb the sphenopalatine, nasopalatine, and the anterior and posterior ethmoid nerves. If required, the external nose can be numbed by anesthetizing the anterior ethmoid, the infraorbital, and/or the nasopalatine nerves. Often, it is necessary to reduce anxiety during a nasal block. Sometimes topical or internal anesthesia may be necessary for children or uncooperative patients. Other times, deep sedation may be required depending on the patient.