Sensory Impairment in Infraorbital Nerve Following Mid-Facial Fractures

중안면골절에 따른 안와하신경의 손상

  • Lee, Hyun-Tae (Department of Plastic & Reconstructive Surgery, College of Medicine, Yeungnam University) ;
  • Kim, Yong-Ha (Department of Plastic & Reconstructive Surgery, College of Medicine, Yeungnam University) ;
  • Kim, Tae-Gon (Department of Plastic & Reconstructive Surgery, College of Medicine, Yeungnam University) ;
  • Lee, Jun-Ho (Department of Plastic & Reconstructive Surgery, College of Medicine, Yeungnam University)
  • 이현태 (영남대학교 의과대학 성형외과학교실) ;
  • 김용하 (영남대학교 의과대학 성형외과학교실) ;
  • 김태곤 (영남대학교 의과대학 성형외과학교실) ;
  • 이준호 (영남대학교 의과대학 성형외과학교실)
  • Received : 2010.08.23
  • Accepted : 2010.10.01
  • Published : 2011.01.10

Abstract

Purpose: Sensory impairment in infraorbital nerve is common symptom following mid-facial fractures. The purpose of this study is to document the incidence of sensory impairment in infraorbital nerve following midfacial fractures and its recovery. Methods: Three hundreds fourteen patients with midfacial fracture were included involving emergence areas of infraorbital nerve. Fractures were classified into zygoma fracture, maxilla fracture, complex comminuted fracture and pure blow out fracture. Neurosensory function was assessed with clinical symptoms and light touch test in infraorbital nerve regions. Patients were followed and sensory function was evaluated immediately, 1, 3 and 6 months after trauma. Results: The total series consisted of 198 zygoma fractures, 19 maxilla fractures, 30 complex comminuted fractures and 67 pure blow out fractures. The incidence of sensory impairment was 60% (63% in zygoma fractures, 84% in maxilla fractures, 93% in complex comminuted fractures, 31% in pure blow out fractures). Persistent sensory impairments were remained in 32% (33% in zygoma fractures, 47% in maxilla fractures, 73% in complex comminuted fractures, 6% in pure blow out fractures) 6 months after trauma. Younger patients had better prognosis than older patients in recovery of infraorbital nerve function ($p$ <0.05, $x^2$-test). Mean recovery time was 11 weeks. Conclusion: The incidence of post-traumatic sensory impairment was different according to fracture types. Age of patients and fracture type were important factors that influence to recovery of sensory impairment. Complex comminuted fracture had poor prognosis, and pure blow out fractures had better prognosis than other fractures.

Keywords

References

  1. Lund K: Fractures of the zygoma; a follow up study on 62 patients. J Oral Surg 29: 557, 1971
  2. Taicher S, Ardekian L, Samet N, Shoshani Y, Kaffe I: Recovery of the infraorbital nerve after zygomatic complex fractures: a preliminary study of different treatment methods. Int J Oral Maxillofac Surg 22: 339, 1993 https://doi.org/10.1016/S0901-5027(05)80662-9
  3. De Man K, Bax WA: The influence of the mode of treatment of zygomatic bone fracture on the healing process of the infraorbital nerve. Br J Oral Maxillofac Surg 26: 419, 1988 https://doi.org/10.1016/0266-4356(88)90095-2
  4. Sakavicius D, Juodzbalys G, Kubilius R, Sabalys GP: Investigation of infraorbital nerve injury following zygomaticomaxillary complex fractures. J Oral Rehabil 35: 903, 2008 https://doi.org/10.1111/j.1365-2842.2008.01888.x
  5. Choi SW, Shin DP, Shin HK, Lee JM: A retrospective study on the injury of infraorbital nerve according to types of orbitozygomatic complex fracture. J Korean Soc Plast Reconstr Surg 30: 20, 2003
  6. Schilli W: Treatment of zygoma fracture. Oral Maxillofac Surg Clin North Am 2: 155, 1990
  7. Zingg M, Laedrach K, Chen J, Chowdhury K, Vuillemin T, Sutter F, Raveh J: Classification and treatment of zygomatic fractures: a review of 1,025 cases. J Oral Maxillofac Surg 50: 778, 1992 https://doi.org/10.1016/0278-2391(92)90266-3
  8. Zachariades N, Papavassiliou D, Papademetriou I: The alteration in sensitivity of the infraorbital nerve following fractures of the zygomatico-maxillary complex. J Craniomaxillofac surg 18: 315, 1990 https://doi.org/10.1016/S1010-5182(05)80539-6
  9. Benoliel R, Birenboim R, Regev E, Eliav E: Neurosensory changes in the infraorbital nerve following zygomatic fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99: 657, 2005 https://doi.org/10.1016/j.tripleo.2004.10.014
  10. Peltomaa J, Rihkanen H: Infraorbital nerve recovery after minimally dislocated facial fractures. Eur Arch Otorhinolaryngol 257: 449, 2000 https://doi.org/10.1007/s004050000264
  11. Renzi G, Carboni A, Perugini M, Giovannetti F, Becelli R: Posttraumatic trigeminal nerve impairment: a prospective analysis of recovery patterns in a series of 103 consecutive facial fractures. J Oral Maxillofac Surg 62: 1341, 2004 https://doi.org/10.1016/j.joms.2004.05.212
  12. Sunderland S: A classification of peripheral nerve injuries producing loss of function. Brain 74: 491, 1951 https://doi.org/10.1093/brain/74.4.491
  13. Shenaq SM, Kim JYS: Repair and grafting of peripheral nerve. In Mathes SJ, Hentz VR (eds): Plastic Surgery, 2nd ed, Philadelphia, Saunders, 2006, p 719