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Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Sensory Optic nerve receives light input from the retinaOphthalmic (V1) branch of trigeminal nerve Frontal nerve (conjunctiva and upper eyelid)Nasociliary nerve (cornea, iris and ciliary muscle)Lacrimal nerve (lacrimal gland)Maxillary (V2) branch of trigeminal nerve Infraorbital nerve (lower eyelid)
Regional Anesthesia
Published in Marwali Harahap, Adel R. Abadir, Anesthesia and Analgesia in Dermatologic Surgery, 2019
Nerve block technique(s) (Fig. 1): Identify the infraorbital foramen. This is located in the midpupillary line approximately 2 cm below the inferior orbital rim.Inject 2 to 3 mL of 1–2% lidocaine (choose concentration after considering volume and dosing limitations) in a fan-shaped pattern circumferentially around the foramen. This will block the infraorbital nerve. Injection depth should be submuscular near the bony surface.Along the zygoma, approximately 2 cm lateral to and 2 cm inferior to the lateral canthus, inject 2 to 3 mL of anesthetic in a fan-shaped pattern as above. This will block the zygomaticotemporal nerve. Injection should be submuscular near the bony surface.
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Maxilla Infraorbital nerve numbness.Malocclusion.Increased mobility (grasp anterior maxilla whilst fixing the face at the nose); however, impacted fractures may not move.Maxillary alveolus moves but nasofrontal area does not – Le Fort I.Maxillary alveolus and nasofrontal area move – Le Fort II.Entire mid-face moves – Le Fort III.
A direct transcutaneous approach to infraorbital nerve biopsy
Published in Orbit, 2022
Kelly H. Yom, Brittany A. Simmons, Lauren E. Hock, Nasreen A. Syed, Keith D. Carter, Matthew J. Thurtell, Erin M. Shriver
To our knowledge, a transcutaneous approach for biopsy of the infraorbital nerve has not yet been described in the literature. As with all surgical procedures, it is important for the surgeon to counsel patients preoperatively and to be aware of the local anatomy. In this case series, four patients underwent minimally invasive transcutaneous infraorbital nerve biopsy, and findings from biopsy were sufficient for diagnosis of perineural invasion of squamous cell carcinoma. All patients had V2 hypoesthesia prior to surgery. If patients present with partial V2 hypoesthesia, they should be counseled that total hypoesthesia may be an expected sequela of the procedure. Postoperatively, all cases displayed good wound healing of the surgical site with no adverse events and no complaints of new or worsening symptoms. Understanding the anatomy of the infraorbital region and infraorbital nerve is necessary to guide the biopsy and prevent iatrogenic injury to surrounding structures.44–46 The infraorbital nerve can be located at its egress from the infraorbital foramen and is often palpable. When palpation is difficult, anatomic landmarks can help predict the location of the infraorbital foramen (Figure 3). Surgeons must be aware of the variations in infraorbital nerve anatomy. Multiple nerve foramina and offshoots of the infraorbital nerve have been reported, and knowledge of these possible variants will allow for proper localization and biopsy of the nerve.46,48
Immediate allograft reconstruction of the infraorbital nerve following resection of polyostotic fibrous dysplasia lesion
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Abelardo Medina, Ignacio Velasco Martinez, Quynh Nguyen
The midface degloving approach with subciliary and palatal sulcular incisions on the left maxilla was used to gain access to the tumor (Figure 2(A)). Soft tissue exploration revealed a compressed infraorbital nerve situated within the PFD tumor (Figure 2(B)) resulting in the need for infraorbital nerve resection. The PFD lesion was completely removed after which was deemed to be a 90-mm tumor in the anterior-posterior plane (Figure 2(C)). After the left hemi-maxillectomy was performed, as part of the PFD lesion removal, the infraorbital nerve was found to have a 70-mm defect in the superior-inferior plane. The proximal stump of the infraorbital nerve was isolated from surrounding tissues and marked with a 2-0 silk suture (Figure 2(D)), and subsequently its end was trimmed in preparation for the nerve repair. The same approach was done with the distal stump of the infraorbital nerve. Thereafter, the ends of a PNA (3-mm in diameter and 70-mm in length) were coapted to the proximal and distal infraorbital nerve ends with interrupted stitches of 8-0 nylon suture. Finally, nerve connectors were used around the coaptation sites to assist with the repair technique (Figure 2(E,F), respectively).
Dynamic soft tissue changes in the orbit after a blowout fracture
Published in Acta Oto-Laryngologica, 2019
Ulrik Ascanius Felding, Olaf E. Damgaard, Sune L. Bloch, Tron A. Darvann, Carsten Thomsen, Peter B. Toft, Christian von Buchwald
Standard diagnostic work up of blowout fractures included examinations performed by an otolaryngologist (author UAF). Diplopia was examined using a campimetry screen and defined as double vision in primary gaze (diplopia looking straight-ahead) or as an isolated peripheral gaze diplopia either within or outside a 30° angle. The anterior–posterior position of the eye was measured using Hertel’s exophthalmometer. Infraorbital nerve damage was defined as either present or absent based on both clinical examination and patient-reported information. Visual acuity was assessed with a Snellen chart. Extraocular muscle movement was tested with a normal H pattern test. Patients were examined as soon as possible after the trauma and again at 10–14 days, 3 months, and 6 months after the trauma. Sequelae after 6 months were defined as having one of the following: reduced visual acuity below 0.8 (20/25) (as a consequence of the orbital trauma), enophthalmos ≥ 2 mm, signs of infraorbital nerve damage, reduced EOM movement, double vision in primary position or double vision not in primary position but within a 30° angle.