Lagophthalmos after V2 Maxillary Nerve Block

Shah, Amit A. MD*; Nedeljkovic, Srdjan S. MD

doi: 10.1213/XAA.0000000000000006
Case Reports: Case Report

We report a previously undescribed complication associated with percutaneous maxillary nerve blockade. After the procedure, the patient reported an inability to close her ipsilateral eye (lagophthalmos). The patient had received 5 mL of 0.5% lidocaine for skin anesthesia. After needle placement was confirmed fluoroscopically, a combination of 80 mg methylprednisolone (2 mL) and 0.25% bupivacaine (3 mL) was administered. Symptoms resolved within 40 minutes. The likely cause was local anesthetic effect on the zygomatic branches of the facial nerve. When subcutaneous local anesthetic is given for maxillary block, smaller volumes should be considered. Doctors and patients should be aware of this complication, which may require treatment with artificial tears or patching of the eye to prevent corneal injury.

From the *Department of Anesthesiology, Yale-New Haven Hospital, New Haven, Connecticut, and Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts.

Accepted for publication September 13, 2013.

Funding: Institutional.

The authors declare no conflicts of interest.

Address correspondence to Srdjan S. Nedeljkovic, MD, Pain Management Center, Brigham and Women’s Hospital, 850 Boylston St., Suite 320, Chestnut Hill, MA 02467. Address e-mail to srdjan@zeus.bwh.harvard.edu.

© 2014 International Anesthesia Research Society