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      Sensory recovery after infraorbital nerve avulsion injury

      case-report

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          Abstract

          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.

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          Factors that influence peripheral nerve regeneration: an electrophysiological study of the monkey median nerve.

          Christian Krarup, R Madison, S Archibald (2001)
          Regeneration in the peripheral nervous system is often incomplete though it is uncertain which factors, such as the type and extent of the injury or the method or timing of repair, determine the degree of functional recovery. Serial electrophysiological techniques were used to follow recovery from median nerve lesions (n = 46) in nonhuman primates over 3 to 4 years, a time span comparable with such lesions in humans. Nerve gap distances of 5, 20, or 50mm were repaired with nerve grafts or collagen-based nerve guide tubes, and three electrophysiological outcome measures were followed: (1) compound muscle action potentials in the abductor pollicis brevis muscle, (2) the number and size of motor units in reinnervated muscle, and (3) compound sensory action potentials from digital nerve. A statistical model was used to assess the influence of three variables (repair type, nerve gap distance, and time to earliest muscle reinnervation) on the final recovery of the outcome measures. Nerve gap distance and the repair type, individually and concertedly, strongly influenced the time to earliest muscle reinnervation, and only time to reinnervation was significant when all three variables were included as outcome predictors. Thus, nerve gap distance and repair type exert their influence through time to muscle reinnervation. These findings emphasize that factors that control early axonal outgrowth influence the final level of recovery attained years later. They also highlight that a time window exists within which axons must grow through the distal nerve stump in order for recovery after nerve lesions to be optimal. Future work should focus on interventions that may accelerate the growth of axons from the lesion site into the distal nerve stump.
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            Sensory regeneration following intraoperatively verified trigeminal nerve injury.

            Kirsi A. Virtanen, O Tenovuo, T Oksa … (2004)
            To follow recovery of sensory function mediated by both myelinated and unmyelinated axons in relation to the type of inferior alveolar nerve (IAN) injury. The authors assessed the function of afferent Abeta-, Adelta-, and C-fibers of the IAN using neurophysiologic (mental nerve blink reflex, sensory nerve conduction [NCS] of the IAN) and quantitative sensory tests (QST; cold, warm, heat pain, and tactile modalities). The tests were done 2 weeks, 1, 3, 6, and 12 months postoperatively and compared to the preoperative baseline in 20 patients undergoing mandibular bilateral sagittal split osteotomy. Nineteen patients underwent intraoperative monitoring. In primarily demyelinating injuries (21/40 nerves), the sensory alteration and all tests normalized on the group level within the first 3 months. After partial axonal lesions (15/40 nerves), neurophysiologic and thermal QST results remained abnormal at 1-year control in a high proportion of the IAN distributions (up to 67%). At 1 year, the tactile QST was abnormal in 40%, but the NCS in 87% of the symptomatic IAN distributions. Neuropathic pain occurred in 5% of the patients, only after severe axonal damage. Sensory nerve conduction and thermal quantitative sensory testing showed incomplete sensory regeneration at 1 year after axonal trigeminal nerve damage. Clinical examination with tactile quantitative sensory testing was less reliable in the follow-up of sensory recovery. Sensory Abeta-, Adelta-, and C-fibers recovered function at similar rates. The trigeminal nerve does not differ from other peripheral nerves as regards susceptibility to neuropathic pain.
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              Anatomical Study of the Infraorbital Nerve and Surrounding Structures for the Surgery of Orbital Floor Fractures.

              YongSeok Nam, Sujin Bahk, SuRak Eo (2017)
              The infraorbital nerve (ION) can easily be damaged by orbital trauma and periorbital surgical manipulations, due to its abutment to the orbital floor. Anatomic variability of the ION and surrounding structures has infrequently been documented. The aim of this study is to give precise anatomical knowledge about the ION with surrounding structures, to avoid iatrogenic injury of the ION during periorbital procedures.Forty orbits of 40 skull subjects (20 males and 20 females) were studied to analyze structures around the ION. The authors located the ION, infraorbital canal/groove (IOC/G), and infraorbital foramen (IOF), using several reference points. The various distances were also measured between those structures, and statistically analyzed. The authors compared the left and right sides, and analyzed the differences between both sexes. The IOF was also investigated regarding the shape and presence of the accessory IOF.Three different types of orbital floor osseous anatomy were made based on macroscopic analysis. Type 1 shows no groove, and the ION enters the canal covered by the roof (5 patients, 12.5%). Type 2 revealed a pseudocanal, which has a very thin, almost transparent roof (26 patients, 65.0%). Type 3 consists of the ION traveling in a true groove, before entering an IOC (9 patients, 22.5%). IOG/C complexes took the upward lateral course, until exiting via the IOF. The mean ± SD length of the IOC was 12.86 ± 3.79 mm, and of the IOG was 16.15 ± 2.88 mm. The calculated combined mean length of the IOC/G complex was found to be 29.01 ± 3.17 mm. An accessory IOF was found in 35% of the skulls (50% in male and 20% in female skulls), with a higher frequency on the left side in both male and female skulls.These results can increase the authors' knowledge of the anatomic variability of the infraorbital region, and help facial plastic surgeons during their surgical manipulations prevent any possible iatrogenic injury of the ION.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Craniofac Surg
                Journal ID (iso-abbrev): Arch Craniofac Surg
                Journal ID (publisher-id): ACFS
                Title: Archives of Craniofacial Surgery
                Publisher: Korean Cleft Palate-Craniofacial Association
                ISSN (Print): 2287-1152
                ISSN (Electronic): 2287-5603
                Publication date (Print): August 2020
                Publication date (Electronic): 20 August 2020
                Volume: 21
                Issue: 4
                Pages: 244-248
                Affiliations
                Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
                Author notes
                Correspondence: Jae Ha Hwang Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea E-mail: psjhhwang@ 123456daum.net
                Author information
                http://orcid.org/0000-0002-3185-2519
                http://orcid.org/0000-0001-8269-2036
                http://orcid.org/0000-0001-6992-8067
                http://orcid.org/0000-0002-6766-4640
                Article
                Publisher ID: acfs-2020-00290
                DOI: 10.7181/acfs.2020.00290
                PMC ID: 7463129
                PubMed ID: 32867414
                SO-VID: e7ba4877-7066-4dcc-b41f-c111ad64653e
                Copyright © Copyright © 2020 The Korean Cleft Palate-Craniofacial Association
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 6 July 2020
                Date revision received : 27 July 2020
                Date accepted : 14 August 2020
                Categories
                Subject: Case Report

                Keywords: evoked potentials,nerve regeneration,trigeminal nerve injuries
                Data availability:
                Keywords: evoked potentials, nerve regeneration, trigeminal nerve injuries

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