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Cosmetic Facial Interventions
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Complications include: Bleeding.Haematoma formation (incidence 4%): Small, non-expanding haematomas after 24 hours may be amenable to aspiration or drainage (by opening the existing incision), followed by a pressure dressing.Expanding haematoma constitutes a surgical emergency, requiring immediate wound exploration and clot evaluation.Temporary nerve paralysis.Permanent nerve paralysis (rare, 0.1%): the most injured nerve is the great auricular nerve, followed by the marginal, buccal and frontal nerves.Pixie ear deformity results from improper incision placement around the lobule and/or tension in the suture line because of overzealous skin flap excision, which can be avoided by preventing any excess tension on the lobule.
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The frontal nerve is a branch of the ophthalmic nerve (V1) that divides into the terminal branches, supraorbital and supratrochlear nerves which can be blocked at one injection point. Indications: frontal craniotomy, surgery on the eye and eyelid, nose and frontal sinus, and in providing analgesia in acute herpes zoster.Procedure: the supraorbital foramen (at the junction of the medial one third and the lateral two-thirds of the orbital rim) is palpated and a 25G needle is inserted beneath the eyebrow and is directed medially and cranially. 1 ml of local anaesthetic is injected to block the supraorbital nerve. To block the supratrochlear nerve, the needle is redirected about 1 cm toward the midline and another ml injected after negative aspiration.Specific complications: haematoma, intravascular injection and damage to the eye.
Temporal Region and Lateral Brow
Published in Ali Pirayesh, Dario Bertossi, Izolda Heydenrych, Aesthetic Facial Anatomy Essentials for Injections, 2020
Krishan Mohan Kapoor, Alberto Marchetti, Hervé Raspaldo, Shino Bay Aguilera, Natalia Manturova, Dario Bertossi
The facial nerve divides within the parotid gland into frontal, zygomatic, buccal, mandibular and cervical branches [14]. The frontal branch crosses the temporal fossa to innervate the frontalis muscle.Frontal nerve injury causes paralysis of the ipsilateral frontal muscle, having important implications in facelift surgery.The course of the frontal branch can be approximated by a line extending from 0.5 cm below the external acoustic meatus to 1.5 cm superior to the orbital rim.The nerve is tightly adherent to bone at the zygomatic arch and subsequently travels upward to the loose areolar connective tissue just below the temporoparietal fascia.The inferior temporal septum is an important anatomical landmark of the frontal branch [15].
Outcomes of conjunctival-Müller’s muscle resection surgery with and without epinephrine in local anesthetic
Published in Orbit, 2022
There were some limitations to our investigation. Our study was retrospective in nature, which limited the ability to completely track certain variables. Typically, 0.8–1 cc of local anesthetic was used at the beginning of each case, however some patients required further injection of the same solution of anesthetic during the procedure, and this was not formally recorded. Any mechanical effect induced by volume would be expected to be transient. Furthermore, in tracking the mean postoperative time that the final MRD1 was recorded, it is possible that this could alter over an extended period of follow-up. Most patients in this study attended our institution from prolonged distances, and hence discharge usually occurs at an average of 3 months from the operation date. However, no patients included in the study have required or requested revision surgery so from the senior author’s experience success has been likely maintained long term. Lastly, some surgeons performing CMMR continue to employ a frontal nerve block for attaining anesthesia34–36 as originally recommended by Putterman et al.5 This study is unable to determine if using epinephrine as an anesthetic adjunct in a frontal nerve block would have an impact on the surgical outcome. Future prospective randomized controlled studies involving larger numbers of patients would help further establish the safety and benefits of using epinephrine for CMMR procedures, including its potential use in an undiluted form in local anesthetic solutions.
Corneal Neurotization: Review of a New Surgical Approach and Its Developments
Published in Seminars in Ophthalmology, 2019
Natalie Wolkow, Larissa A. Habib, Michael K. Yoon, Suzanne K. Freitag
Jowett and Pineda described an approach that avoided the use of the frontal nerve branches, but which still uses an interpositional graft.22 Instead of using a supraorbital or supratrochlear nerve as the donor sensory nerve, the greater auricular nerve was selected. A sural nerve graft was used to connect the greater auricular nerve to the anesthetic cornea. The sural nerve was harvested from the leg endoscopically. The ipsilateral greater auricular nerve was exposed through an infra-auricular neck incision. A fornix-based inferior peritomy was performed 7 mm posterior to the limbus. A Wright fascial needle was passed below the tarsus of the lower eyelid through the inferior peritomy, through the cheek and out the neck incision. The sural nerve graft was threaded through the eye of the needle and tunneled through the cheek to connect the greater auricular nerve to the ocular surface. The sural nerve fascicles were inserted into scleral-corneal tunnels in the corneal stroma and the conjunctival incision was closed. The greater auricular nerve was connected to the sural nerve with 10-0 nylon sutures. This procedure was performed on two patients, both of whom had improved corneal sensation. Post-operatively abnormal sensations were described in the earlobes.
Review for Disease of the Year: Varicella Zoster Virus-Induced Anterior Uveitis
Published in Ocular Immunology and Inflammation, 2018
Ilknur Tugal-Tutkun, Luca Cimino, Yonca Aydin Akova
The trigeminal dermatomes are most commonly affected by clinically manifest HZ.15,16 The involvement of the first or ophthalmic division of this nerve is called herpes zoster ophthalmicus (HZO),17 and it is about 20 times more common than the involvement of the second or third division. The ophthalmic division gives rise to three terminal branches: the lacrimal, frontal, and nasociliary branches. Within that division, the frontal nerve is the most commonly involved and innervates the upper lid, forehead, and some superior conjunctiva. The nasociliary branch, the primary sensory nerve to the eyeball, innervates the skin of the tip of the nose and divides further into the long ciliary nerves, which provide sensory innervation to the globe, including the sclera, cornea, and uvea.17 For this reason, the involvement of the tip of the nose, called Hutchinson’s sign, is highly correlated with ophthalmic involvement.18,(Figure 1) Ocular disease can also occur in the absence of skin rash (zoster sine herpete).19 The incidence of HZO was found to be 30.9 per 100,000 person-years in a retrospective population-based cohort study in Hawaii.20