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Botulinum toxin complications and management
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Should you hit the supraorbital nerve, the patient will likely report immediate, terrible pain shooting up to their scalp at the time of injection. This neuralgia will be intense and similar to brain freeze, which we have all encountered at some point eating a cold ice cream. This pain may remain for several days to weeks before resolution due to the slow rate of healing of peripheral nerves. Advise your patients to take sufficient analgesia during this time and reassure them it should settle over due course. Most of the time the symptoms are brought by brushing the nerve; however, research suggests that even if you directly infiltrate and traumatise the nerve with your needle then it should fully rejuvenate within two months.
Anatomy of the Forehead and Periocular Region
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Marcelo B. Antunes, Stephen A. Goldstein
The ophthalmic branch of the trigeminal nerve provides the sensory innervation to the upper third of the face. This nerve has two terminal branches, the supraorbital and the supratrochlear nerves. The supraorbital nerve passes through the supraorbital foramen, innervating the upper eyelid and then ascends on the forehead to innervate the lateral and superior parts of the forehead and the scalp. The supratrochlear nerve passes between the superior oblique muscle in the orbit and the supraorbital foramen and curves superiorly to innervate the skin of the inferior and central portion of the forehead (Figure 4.3).
Regional Anesthesia
Published in Marwali Harahap, Adel R. Abadir, Anesthesia and Analgesia in Dermatologic Surgery, 2019
Nerve block technique(s) (Fig. 1): Locate the supraorbital notch. This is palpable along the superior orbital rim in the midpupillary line.Inject 2 to 3 mL of 1–2% lidocaine (choose concentration after considering volume and dosing limitations) in a fan-shaped pattern superior to the supraorbital notch. This will block the supraorbital nerve. Injection depth should be submuscular (deep to the corrugator) near the bony surface.Directly medial to the supraorbital notch, along the superiomedial orbital rim, inject another 2 to 3 mL of anesthetic in a fan-shaped pattern as above. This will block the supratrochlear nerve.
Case series of 100 supraorbital mini-craniotomies in patients with good grade aneurysmal subarachnoid haemorrhage at a single neurosurgical Centre
Published in British Journal of Neurosurgery, 2022
Gopiga Thanabalasundaram, Wai Cheong Soon, Athiththan Ponnampalam, Howard L. Brydon
A period of reduced consciousness occurred in 18 patients and seven of them required a period of ventilation. Hydrocephalus needing VP shunts developed in nine patients and eight patients suffered post-operative seizures. One of these patients had seizures pre-operatively. An uncomplicated recovery occurred in 79% of patients. There were no instances of the facial nerve or frontalis palsy, temporalis atrophy, or jaw stiffness post-operatively. Three patients developed wound infections and two of them needed bone flap removal requiring a cranioplasty later. The third patient settled with antibiotics but needed a wound revision due to bone flap atrophy. Of these three patients, 2 patients had frontal sinus breach intra-operatively. Six patients stated that they were unhappy with the cosmetic outcome of the wound; one of them later had a filling of a forehead depression due to a partly atrophic bone flap and was then satisfied. Forehead numbness due to supra-orbital nerve palsy occurred in 21% of patients.
Neurotrophic Keratopathy in Pediatric Patients
Published in Seminars in Ophthalmology, 2021
Since this study, several modifications of the procedure have been described and can be categorized into direct or indirect approaches. The direct approach involves re-routing a sensory nerve to the cornea, like that used by Terzis et al. One direct approach described by Terzis et al. involves using the ipsilateral instead of contralateral supraorbital nerve. This is accomplished by dissecting branches of the supraorbital nerve above the supraorbital notch and then tunneling these branches through a lid crease incision, into the superior conjunctival fornix and into the sub-Tenon’s space to the corneal limbus.2 Leyngold et al. described a similar procedure in which the ipsilateral or contralateral supraorbital nerve can be accessed endoscopically. First, the supraorbital nerve is identified by tunneling through a lid crease incision up to the supraorbital rim. Dissection of the supraorbital nerve is then carried out superiorly for 1 cm. Two vertical incisions are then made posterior to the hairline and subperiosteal dissection is performed endoscopically to the initial dissection of the supraorbital nerve. The periosteum is then incised to connect the two planes and the supraorbital nerve branches are then tunneled to the neurotrophic eye, passed through the sub-Tenon’s space and secured in a perilimbal fashion.42,44,45
Hypnotizability-Related Effects of Pain Expectation on the Later Modulation of Cortical Connectivity
Published in International Journal of Clinical and Experimental Hypnosis, 2020
Seyedeh-Parisa Zarei, Lucia Briscese, Simone Capitani, Bruno Rossi, Maria C. Carboncini, Enrica L. Santarcangelo, Ali Motie Nasrabadi
The findings indicate that the electrical stimulation of the right supraorbital nerve suppresses global connectivity over widespread brain regions which address different aspects of pain processing. In fact, the experience of nociceptive stimuli and the reaction to them require information flow through sensory-, conceptual-, cognitive- and motor-related modules distributed within extended brain network (Peng et al., 2015; Ploner et al., 2009). The brain network associated with the basal condition is dominated by spontaneous activity (Berger, 1929; Peng et al., 2015; Ploner et al., 2006; Raij et al., 2004) and connectivity (Petti et al., 2016; Scally et al., 2018) at alpha and beta frequencies. The suppression of connectivity at these frequency bands could reflect the inhibition of basal network due to the involvement of the brain in stimulus processing. Modulation of the whole brain connectivity network has been also observed in other authors’ reports (De Tommaso et al., 2015; Leistritz et al., 2013).