• Archives of Plastic Surgery
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• v.47 no.6
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• pp.559-566
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• 2020

Background Infraorbital nerve dysfunction is commonly reported after zygomaticomaxillary complex fractures. We evaluated sensory changes in four designated areas (eyelid, nose, zygoma, and lip) innervated by the infraorbital nerve. This evaluation was conducted using the static two-point discrimination test and the vibration threshold test. We assessed the diagnostic significance of the blink reflex in patients with infraorbital nerve dysfunction. Methods This study included 18 patients, all of whom complained of some degree of infraorbital nerve dysfunction preoperatively. A visual analog scale, the infraorbital blink reflex, static two-point discrimination, and the vibration threshold were assessed preoperatively, at 1 month postoperatively (T1), and at a final follow-up that took place at least 4 months postoperatively (T4). The results were analyzed using a multilevel generalized linear mixed model. Results Scores on the visual analog scale significantly improved at T1 and T4. The infraorbital blink reflex significantly improved at T4. Visual analog scale scores improved more rapidly than the infraorbital blink reflex. Two-point discrimination significantly improved in all areas at T4, and the vibration perception threshold significantly improved in the eyelid at T4. Conclusions Recovery of the infraorbital blink reflex reflected the recovery of infraorbital nerve dysfunction. We also determined that the lip tended to recover later than the other areas innervated by the infraorbital nerve.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.2
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• pp.74-77
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• 2015

Objectives: Transpositioning of the inferior alveolar nerve to prevent injury in lower jaw has been advocated for orthognathic, pre-prosthetic and for implant placement procedures. However, the concept of infra-orbital nerve repositioning in cases of mid-face fractures remains unexplored. The infraorbital nerve may be involved in trauma to the zygomatic complex which often results in sensory disturbance of the area innervated by it. Ten patients with infraorbital nerve entrapment were treated in similar way at our maxillofacial surgery centre. Materials and Methods: In this article we are reporting three cases of zygomatico-maxillary complex fracture in which intra-operative repositioning of infra-orbital nerve into the orbital floor was done. This was done to release the nerve from fractured segments and to reduce the postoperative neural complications, to gain better access to fracture site and ease in plate fixation. This procedure also decompresses the nerve which releases it off the soft tissue entrapment caused due to trauma and the organized clot at the fractured site. Results: There was no evidence of sensory disturbance during their three month follow-up in any of the patient. Conclusion: Infraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.2
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• pp.150-156
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• 2001

This study was performed to investigate the changes of nerve after the injection of alcohol and glycerol at the infraorbital nerve in rats. Using the eighteen Sprague-Dawley rats, weighing $200{\sim}250g$, 99% alcohol, pure glycerol, and sterile saline was injected to the epineurium of the infraorbital nerve. Glycerol injected rats were devided into 0.01ml, 0.03ml and 0.05ml groups. The alcohol and control group were injected 0.03ml at the left infraorbital nerve. The following results were obtained by histopathological examination after 1 week, 1 month, and 3 months. A few inflammatory cell infiltration and no signs of nerve degeneration were noted in control group. Total nerve degeneration was noted in the alcohol group and no regeneration was noted in 1month, and partial regeneration was noted at 3month. The nerve degeneration was noted at the periphery of nerve bundle in 0.01ml glycerol injection group. Total degeneration was noted in the 0.03ml and 0.05ml glycerol injection group and the degree was propotional to dose. These results suggest that injection of alcohol and glycerol are effective to nerve blockage by nerve degeneration, and nerve degeneration by glycerol injection is propotional to dose and nerve regeneration by glycerol injection is inversely propotional to dose.

• Archives of Craniofacial Surgery
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• v.19 no.3
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• pp.231-234
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• 2018

A schwannoma is a benign tumor that develops from Schwann cells. It is known to occur more frequently in women than men, and about one third of schwannoma cases occur in the head and neck area. It is also known to originate mainly in the auditory nerve. However, it is rarely associated with the trigeminal nerve, and especially, schwannomas related to the infraorbital nerve are very rare. we report a rare case of a schwannoma involving the infraorbital branch of the trigeminal nerve in a 45-year old male adult. The patient underwent physical examination and magnetic resonance imaging. The mass was approached through subciliary approach that is familiar to the plastic surgeon and completely resected. Histopathological findings showed pointed to a benign schwannoma. Infraorbital nerve schwannoma is difficult to distinguish from other diseases by means of clinical symptoms, physical findings, or imaging. In spite of its rarity, infraorbital nerve schwannoma may be considered a possible diagnosis in the case of mass on cheek. Assessment by computed tomography or magnetic resonance imaging is necessary for proper diagnosis. About the surgical approach, excision through the subciliary approach should be considered rather than the direct transfacial approach in view of stability, cosmetic effects, and familiarity.

• The Korean Journal of Pain
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• v.5 no.1
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• pp.76-79
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• 1992

Trigeminal neuralgia is a condition characterized by excruciating paroxysms of pain in lips, gums, cheek, or chin, and very rarely, in the distribution of the ophthalmic division of the trigeminal nerve. There are many treatments of trigeminal neuralgia, such as, medical treatment, electrical stimulation, radiation therapy and ablative procedures. Infraorbital nerve block with pure ethyl alcohol is an ablation procedure for trigeminal neuralgia. We injected pure ethyl alcohol into the infraorbital foramen for pain control. The results were as follows; 1) The infraorbital nerve block with pure alcohol was an a simple and an effective method. 2) Complication, included a mild sensory deficit and mild edema over the infraorbital area.

• Archives of Craniofacial Surgery
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• v.21 no.4
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• pp.244-248
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• 2020

The infraorbital nerve is a branch of the trigeminal nerve. Injury to the infraorbital nerve can be caused by trauma, including various facial fractures. Due to this nerve injury, patients complain of numbness and pain in the entire cheek, the ala of nose, and upper lip. In general, spontaneous sensory recovery is expected after decompressive surgery. If nerve transection is confirmed, however, neurorrhaphy is typically performed. Here, we present a case in which microsurgery was not performed in a patient with Sunderland grade V avulsion injury of the infraorbital nerve due to a facial bone fracture. Gradual nerve function recovery was confirmed to be possible with conservative treatment and rehabilitation alone. These findings suggest that the nerve function recovery can be expected with conservative treatment, even for severe nerve injury for which microsurgery cannot be considered.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.43-47
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• 2011

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.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.276-282
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• 1989

This is a report of 4 case of external decompression about infraorbital paresthesia with transconjuctival incision in zygomatic complex fratures. The results are as follows. 1. Decompression for infraorbital nerve injury is indicated if paresthesia exists 5-7 days, although the patients have nondisplaced fractures of zygomatic complex. 2. Satisfactory results are expected within 1-2 weeks after surgical operation in early decompression of infraorbital nerve. 3. Paresthesia of the infraorbital nerve following fracture of the zygomatic complex may be persistent complication. 4. Scar tissues on the face are avoided with transconjuctival approach.

• Archives of Craniofacial Surgery
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• v.14 no.1
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• pp.61-64
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• 2013

Schwannomas are well-differentiated solitary benign tumors that originate from the schwann cells of the nerve sheath. They can readily occur in the head and neck regions, but the schwannoma originating from the infraorbital nerve is extremely rare and usually painless, slow-growing, and without specific symptoms. The author experienced a rare case of infraorbital schwannoma, which was completely removed through the intraoral approach. A 20-year-old woman was admitted to our hospital for a painless, solid and circular mass located on the right infraorbital region. The eyeball movement and visual field were normal. There was no globe displacement or proptosis. Preoperative computed tomography demonstrated $13{\times}10{\times}5mm$-sized soft tissue mass. On March 2011, the mass was removed through an intraoral approach. On histopathological examination, the gross specimen consisted of a smooth, well-encapsulated and light yellowish solid mass, measuring $12{\times}7{\times}5mm$. Microscopically, it presented a typical manifestation of schwannoma with Antoni A area with Verocay body, and Antoni B area on H&E stain. The result of the immunohistochemical staining was positive for the S-100 protein. The patient had hypoesthesia of the nasal septum and vestibule in the postoperative period, and this finding confirmed that the internal nasal branch of infraorbital nerve was the nerve in which the schwannoma originated. Infraorbital schwannomas are very rare and must be included in the differential diagnosis of the orbital masses inferior to the eyeball. In the case of early diagnosis, the small-sized infraorbital schwannomas can be completely removed without any scar through an intraoral approach.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.675-679
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• 2008

Purpose: In the orbital floor fracture, sensory impairment due to the damage of the infraorbital nerve is one of the most common symptom and complication. In this report, we have the assumption that tailoring of $medpor^{(R)}$ for decompression may have correlations to the damage and regeneration of the nerve. Methods: Among patients who had open reduction for pure orbital floor fracture in our hospital from March 2005 to March 2008, we selected 80 cases. In 40 cases, we inserted tailored $medpor^{(R)}$, and in other 40 cases, non-tailored $medpor^{(R)}$ was inserted. Patient's reports were obtained and analyzed, and the pin-prick test and the 2-point discrimination test on the infraorbital nerve regions were done for testing the sensory impairments. Results: The results show that the patients who adopted sculpture of $medpor^{(R)}$ showed higher tendency of recovery of sensory impairments in the patient's subjective report, static touch sensation, static two point discrimination using. And in postoperative 3 months, there are statistically significant recovery of sensory symptoms, signs and the result of sensory tests. Conclusion: From these results, tailored $medpor^{(R)}$ in reconstruction of orbital wall fracture may improve recovery of sensory impairments for decreasing of compression of infraorbital nerve.