A Variation of the Infraorbital Nerve

2010 ◽  
Vol 67 (3) ◽  
pp. onsE315-onsE315 ◽  
Author(s):  
R. Shane Tubbs ◽  
Marios Loukas ◽  
William R. May ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Trigeminal Nerve ◽  
Clinical Presentation ◽  
Practical Importance ◽  
Pterygopalatine Fossa ◽  
Infraorbital Nerve ◽  
Nerve Branch ◽  
Male Specimen ◽  
Maxillary Nerve ◽  
Pterygoid Plate ◽  
The Face

Abstract OBJECTIVE: We report the case of a seemingly rare variation of a branch of the trigeminal nerve. This unusual finding is of practical importance to the neurosurgeon because ablation of this nerve(s) in such a case would require modification of technique. The existence of a bifurcated infraorbital nerve is also relevant for application of local anesthesia to portions of the face innervated by the maxillary nerve. CLINICAL PRESENTATION: During cadaveric dissection of the face of a male specimen, 2 branches of the infraorbital nerve were identified emanating onto the face. The 2 branches entered separate osseous canals within the orbit to emerge via 2 infraorbital foramina. INTERVENTION: The unusual variation of the trigeminal nerve branch in the reported case necessitates a change in the way in which the nerve is blocked clinically. A common practice involves blocking the infraorbital nerve as it emerges from the infraorbital foramen. The needle is aimed superiorly, posteriorly, and slightly laterally; however, to provide adequate anesthesia to both branches of the infraorbital nerve, as reported here, a needle can be inserted between the zygomatic arch and the notch of the mandible in the pterygopalatine fossa. After the needle contacts the lateral pterygoid plate, it is withdrawn slightly and angled both superiorly and anteriorly to pass into the pterygopalatine fossa. CONCLUSION: Although apparently uncommon, such derangement of the infraorbital nerve should be kept in mind by surgeons during surgical procedures in the region for treatment of various disorders including trigeminal neuralgia.

Technical considerations for approaches to the ultrasound-guided maxillary nerve block via the pterygopalatine fossa: a literature review

2020 ◽  
Vol 45 (4) ◽  
pp. 301-305 ◽  
Author(s):  
Ariana Anugerah ◽  
Kim Nguyen ◽  
Antoun Nader
Keyword(s):  
Nerve Block ◽  
Trigeminal Nerve ◽  
Case Series ◽  
Pterygopalatine Fossa ◽  
Ultrasound Guided ◽  
Maxillary Nerve ◽  
Pubmed Database ◽  
Ideal Approach ◽  
Maxillary Nerve Block ◽  
The Ideal

Background and objectivesBlockade of the trigeminal nerve and its branches is an effective diagnostic tool and potential treatment of facial pain. Ultrasound-guided injections in the pterygopalatine fossa (PPF) to block the trigeminal nerve divisions and sphenopalatine ganglion have been described but a consensus has yet to be reached over the ideal approach. We sought to delineate and compare the various approaches to the ultrasound-guided trigeminal divisions blockade via the PPF.MethodsThe literature search was performed by searching the National Library of Medicine’s PubMed database, the Cochrane Database of Systematic Reviews and Google Scholar within the date range of January 2009–March 2019 for keywords targeted toward “trigeminal nerve,” “maxillary nerve,” or “pterygopalatine fossa,” “ultrasound,” and “nerve block,” using an English language restriction. Six papers were included in the final review: one prospective double-blinded randomized controlled trial, one prospective descriptive study, one case series, two case reports, and one cadaveric study.ResultsThere are three main approaches to the ultrasound-guided trigeminal nerve branches blockade via the PPF: anterior infrazygomatic in-plane, posterior infrazygomatic in-plane, and suprazygomatic out-of-plane approaches. Each showed injectate spread to the PPF in cadaver, adult and pediatric patients, respectively.1–5 Injectate used varied from 3 to 5 mL to 0.15 mL/kg.ConclusionsThese studies demonstrated that the PPF is a readily accessible target for the ultrasound-guided maxillary nerve block via three main approaches.2 The ideal approach is yet to be determined and must be further explored.

The Trigeminal Trophic Syndrome: An Unusual Cause of Face Pain, Dysaesthesias, Anaesthesia and Skin/Soft Tissue Lesions

Cephalalgia ◽  
2008 ◽  
Vol 28 (9) ◽  
pp. 980-985 ◽  
Author(s):  
I Garza
Keyword(s):  
Trigeminal Nerve ◽  
Age Of Onset ◽  
Case Series ◽  
Infraorbital Nerve ◽  
Face Pain ◽  
Case Series Report ◽  
The Face ◽  
Trigeminal Trophic Syndrome ◽  
Record Review ◽  
Retrospective Medical Record Review

The trigeminal trophic syndrome is an unusual consequence of trigeminal nerve injury that results in facial anaesthesia, dysaesthesia and skin ulceration. Limited knowledge is available. The aim of this study was to increase the knowledge of this syndrome by performing a retrospective medical record review and case series report. Fourteen cases were identified. The female : male ratio was 6:1. Mean age of onset was 45 years (range 6-82). The cause was iatrogenic in most. Latent period to onset ranged from days to almost one decade. The majority ( n = 12) had bothersome dysaesthesias. Most ( n = 9) self-manipulated the face; a third ( n = 5) did not. Most ulcers affected the second trigeminal division, mainly in the infraorbital nerve distribution. Neuropathic and/or neuralgic facial pain occurred in 50% ( n = 7). Pain intensity was severe in most (n = 6). Gabapentin gave relief in two. To conclude, trigeminal trophic syndrome follows injury to the trigeminal nerve or its nuclei. For unclear reasons, most ulcerations follow infraorbital nerve distribution. Self-manipulation may contribute to ulcer development rather than being required. Gabapentin may help pain.

scholarly journals Infraorbital nerve: a surgically relevant landmark for the pterygopalatine fossa, cavernous sinus, and anterolateral skull base in endoscopic transmaxillary approaches

2016 ◽  
Vol 125 (6) ◽  
pp. 1460-1468 ◽  
Author(s):  
Ali M. Elhadi ◽  
Hasan A. Zaidi ◽  
Kaan Yagmurlu ◽  
Shah Ahmed ◽  
Albert L. Rhoton ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Infratemporal Fossa ◽  
Pterygopalatine Fossa ◽  
Infraorbital Nerve ◽  
External Carotid ◽  
Infraorbital Foramen ◽  
Foramen Rotundum

OBJECTIVE Endoscopic transmaxillary approaches (ETMAs) address pathology of the anterolateral skull base, including the cavernous sinus, pterygopalatine fossa, and infratemporal fossa. This anatomically complex region contains branches of the trigeminal nerve and external carotid artery and is in proximity to the internal carotid artery. The authors postulated, on the basis of intraoperative observations, that the infraorbital nerve (ION) is a useful surgical landmark for navigating this region; therefore, they studied the anatomy of the ION and its relationships to critical neurovascular structures and the maxillary nerve (V2) encountered in ETMAs. METHODS Endoscopic anatomical dissections were performed bilaterally in 5 silicone-injected, formalin-fixed cadaveric heads (10 sides). Endonasal transmaxillary and direct transmaxillary (Caldwell-Luc) approaches were performed, and anatomical correlations were analyzed and documented. Stereotactic imaging of each specimen was performed to correlate landmarks and enable precise measurement of each segment. RESULTS The ION was readily identified in the roof of the maxillary sinus at the beginning of the surgical procedure in all specimens. Anatomical dissections of the ION and the maxillary branch of the trigeminal nerve (V2) to the cavernous sinus suggested that the ION/V2 complex has 4 distinct segments that may have implications in endoscopic approaches: 1) Segment I, the cutaneous segment of the ION and its terminal branches (5–11 branches) to the face, distal to the infraorbital foramen; 2) Segment II, the orbitomaxillary segment of the ION within the infraorbital canal from the infraorbital foramen along the infraorbital groove (length 12 ± 3.2 mm); 3) Segment III, the pterygopalatine segment within the pterygopalatine fossa, which starts at the infraorbital groove to the foramen rotundum (13 ± 2.5 mm); and 4) Segment IV, the cavernous segment from the foramen rotundum to the trigeminal ganglion (15 ± 4.1 mm), which passes in the lateral wall of the cavernous sinus. The relationship of the ION/V2 complex to the contents of the cavernous sinus, carotid artery, and pterygopalatine fossa is described in the text. CONCLUSIONS The ION/V2 complex is an easily identifiable and potentially useful surgical landmark to the foramen rotundum, cavernous sinus, carotid artery, pterygopalatine fossa, and anterolateral skull base during ETMAs.

scholarly journals Selective Denervation of the Facial Dermato-Muscular Complex in the Rat: Experimental Model and Anatomical Basis

2021 ◽  
Vol 15 ◽  
Author(s):  
Vlad Tereshenko ◽  
Dominik C. Dotzauer ◽  
Udo Maierhofer ◽  
Christopher Festin ◽  
Matthias Luft ◽  
...  
Keyword(s):  
Trigeminal Nerve ◽  
Cortical Plasticity ◽  
Neuromuscular Junctions ◽  
Cranial Nerves ◽  
Experimental Models ◽  
Infraorbital Nerve ◽  
Immunofluorescent Staining ◽  
Surgical Model ◽  
Anatomical Basis ◽  
The Face

The facial dermato-muscular system consists of highly specialized muscles tightly adhering to the overlaying skin and thus form a complex morphological conglomerate. This is the anatomical and functional basis for versatile facial expressions, which are essential for human social interaction. The neural innervation of the facial skin and muscles occurs via branches of the trigeminal and facial nerves. These are also the most commonly pathologically affected cranial nerves, often requiring surgical treatment. Hence, experimental models for researching these nerves and their pathologies are highly relevant to study pathophysiology and nerve regeneration. Experimental models for the distinctive investigation of the complex afferent and efferent interplay within facial structures are scarce. In this study, we established a robust surgical model for distinctive exploration of facial structures after complete elimination of afferent or efferent innervation in the rat. Animals were allocated into two groups according to the surgical procedure. In the first group, the facial nerve and in the second all distal cutaneous branches of the trigeminal nerve were transected unilaterally. All animals survived and no higher burden was caused by the procedures. Whisker pad movements were documented with video recordings 4 weeks after surgery and showed successful denervation. Whole-mount immunofluorescent staining of facial muscles was performed to visualize the innervation pattern of the neuromuscular junctions. Comprehensive quantitative analysis revealed large differences in afferent axon counts in the cutaneous branches of the trigeminal nerve. Axon number was the highest in the infraorbital nerve (28,625 ± 2,519), followed by the supraorbital nerve (2,131 ± 413), the mental nerve (3,062 ± 341), and the cutaneous branch of the mylohyoid nerve (343 ± 78). Overall, this surgical model is robust and reliable for distinctive surgical deafferentation or deefferentation of the face. It may be used for investigating cortical plasticity, the neurobiological mechanisms behind various clinically relevant conditions like facial paralysis or trigeminal neuralgia as well as local anesthesia in the face and oral cavity.

scholarly journals Transcutaneous trigeminal nerve stimulation modulates the hand blink reflex

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Beniamina Mercante ◽  
Nicola Loi ◽  
Francesca Ginatempo ◽  
Monica Biggio ◽  
Andrea Manca ◽  
...  
Keyword(s):  
Median Nerve ◽  
Trigeminal Nerve ◽  
Nerve Stimulation ◽  
Blink Reflex ◽  
Infraorbital Nerve ◽  
Hand Position ◽  
Median Nerve Stimulation ◽  
Trigeminal Nerve Stimulation ◽  
Before And After ◽  
The Face

AbstractThe hand-blink reflex (HBR) is a subcortical response, elicited by the electrical stimulation of the median nerve, whose magnitude is specifically modulated according to the spatial properties of the defensive peripersonal space (DPPS) of the face. For these reasons, the HBR is commonly used as a model to assess the DPPS of the face. Little is known on the effects induced by the activation of cutaneous afferents from the face on the DPPS of the face. Therefore, we tested the effect of non-painful transcutaneous trigeminal nerve stimulation (TNS) on the amplitude of the HBR. Fifteen healthy participants underwent HBR recording before and after 20 min of sham- and real-TNS delivered bilaterally to the infraorbital nerve in two separate sessions. The HBR was recorded bilaterally from the orbicularis oculi muscles, following non-painful median nerve stimulation at the wrist. The HBR amplitude was assessed in the “hand‐far” and “hand‐near” conditions, relative to the hand position in respect to the face. The amplitudes of the hand-far and hand-near HBR were measured bilaterally before and after sham- and real-TNS. Real-TNS significantly reduced the magnitude of the HBR, while sham-TNS had no significant effect. The inhibitory effect of TNS was of similar extent on both the hand-far and hand-near components of the HBR, which suggests an action exerted mainly at brainstem level.

Locating and Preserving the Sphenopalatine Ganglion in Endoscopic Endonasal Pterygopalatine Fossa Surgery: An Anatomical Study

2019 ◽  
Vol 34 (3) ◽  
pp. 348-351
Author(s):  
Daniel B. Spielman ◽  
Matthew Kim ◽  
Jonathan Overdevest ◽  
David A. Gudis
Keyword(s):  
Trigeminal Nerve ◽  
Anatomical Study ◽  
Surgical Anatomy ◽  
Pterygopalatine Fossa ◽  
Maxillary Artery ◽  
Sphenopalatine Ganglion ◽  
Nerve Branch ◽  
Endoscopic Endonasal ◽  
Sphenopalatine Foramen ◽  
Dissection Technique

Background The pterygopalatine fossa (PPF) contains numerous important neurovascular structures; notably, the sphenopalatine ganglion (SPG), the maxillary branch of the trigeminal nerve (V2), and the internal maxillary artery. With the advent of extended endoscopic endonasal surgery, the surgical anatomy of the PPF warrants increased investigation. Intraoperative dissection and preservation of the SPG is essential to prevent postoperative xeropthalmia and facial hypoesthesia. Objective This study aims to (1) describe a novel dissection technique for identifying the SPG and (2) define the SPG location relative to the sphenopalatine foramen (SPF), which is a consistently identifiable landmark. Methods Eight cadaveric PPFs were dissected in step-wise fashion. An endoscopic medial maxillectomy was performed, the SPF was identified, and the posterior maxillary wall was resected. The maxillary branch of the trigeminal nerve (V2) was identified anterolaterally in its infraorbital canal and traced medially to identify the pterygopalatine nerve to the SPG. The lateral distance and superior/inferior distance from the SPG to the fixed SPF was measured. Results The surgical technique described allowed for reliable identification of the SPG. The SPG was located on average 4.5 ± 1.1 mm lateral and 1 ± 1.4 mm inferior to the SPF. Conclusion Identification and preservation of the SPG is necessary to prevent complications in endoscopic endonasal PPF surgery. The SPG can be reliably located near the SPF by following the pterygopalatine nerve branch of V2.

TRIGEMINAL PROJECTIONS IN THE RETICULAR FORMATION OF THE PONS IN THE CAT

1962 ◽  
Vol 40 (1) ◽  
pp. 7-12
Author(s):  
J. M. Langlois ◽  
Guy Lamarche
Keyword(s):  
Reticular Formation ◽  
Trigeminal Nerve ◽  
Unit Activity ◽  
Functional Organization ◽  
Pontine Reticular Formation ◽  
Recording Unit ◽  
Spatial Convergence ◽  
The Face ◽  
High Degree ◽  
Stimulation Of

The projections of the trigeminal nerve in the pontine reticular formation of the cat have been investigated by recording unit activity, after physiological stimulation of the face, in 30 "encéphales isolés" preparations. No somatotopical arrangement was found but a high degree of spatial convergence onto pontine reticular units exists and a certain degree of functional organization was observed.

Studies on the storage of potatoes. III. The composition of the atmosphere in a potato clamp

1950 ◽  
Vol 40 (3) ◽  
pp. 227-232 ◽  
Author(s):  
E. M. Crook ◽  
D. J. Watson
Keyword(s):  
Multiple Regression ◽  
Wind Velocity ◽  
Practical Importance ◽  
Oxygen Depletion ◽  
Unsaturated Compounds ◽  
The Face ◽  
Flow Through ◽  
The Mean ◽  
Oxygen Concentrations

The CO2 concentration in the atmosphere of a potato clamp varied between 0·06 and 0·86%. The sum of CO2 and oxygen concentrations remained approximately constant at 21%. The CO2 concentration increased with time from December to April. This was attributed to increase in the rate of respiration of the potatoes caused by rise of temperature. Wind blowing in the direction normal to the face of the clamp reduced the COa concentration, presumably by causing external air to flow through the clamp coverings. A multiple regression of CO2 concentration on temperature of the potatoes at the time of sampling, and on the mean component of wind velocity normal to the clamp face estimated over a period of 3 hr. before the time of sampling, accounted for 64% of the variance between sampling occasions.Unsaturated compounds were detected in the clamp atmosphere by absorption in bromine; the concentration of these, expressed as ethylene, varied between 0·004 and 0·025%.The magnitude of CO2 accumulation and oxygen depletion in the clamp atmosphere was too small to produce effects of practical importance on the storage behaviour of the potatoes. If the unsaturated compounds were ethylene, the concentration present was sufficient to cause appreciable retardation of sprouting.

scholarly journals Primary Malignant Tumours of the Trigeminal Nerve

1986 ◽  
Vol 13 (2) ◽  
pp. 146-148 ◽  
Author(s):  
F.B. Maroun ◽  
M. Sadler ◽  
G.P. Murray ◽  
M. Mangan ◽  
G. Mathieson ◽  
...  
Keyword(s):  
Trigeminal Nerve ◽  
Clinical Presentation ◽  
Malignant Schwannoma ◽  
Pathological Features ◽  
Malignant Tumours

ABSTRACT:We report a case of primary malignant schwannoma of the trigeminal nerve, and review the 5 previously reported cases. Clinical presentation, along with radiological and pathological features are discussed.

Endoscopic Transnasal Resection of Ectopic Esthesioneuroblastoma in the Pterygopalatine Fossa: Technical Case Report

2009 ◽  
Vol 65 (suppl_6) ◽  
pp. onsE112-onsE113 ◽  
Author(s):  
Satoru Kodama ◽  
Toshiaki Kawano ◽  
Masashi Suzuki
Keyword(s):  
Clinical Presentation ◽  
Malignant Tumors ◽  
Malignant Neoplasm ◽  
Complete Removal ◽  
Pterygopalatine Fossa ◽  
Open Approach ◽  
Transnasal Approach ◽  
Olfactory Neuroepithelium ◽  
Endoscopic Transnasal Approach ◽  
Left Maxillary Sinus

Abstract Objective: Esthesioneuroblastoma is a rare, malignant neoplasm arising from the olfactory neuroepithelium in the upper nasal cavity. Even more rare is ectopic esthesioneuroblastoma developing from the region outside the olfactory epithelium. In addition, tumors occurring in the pterygopalatine fossa (PPF) are uncommon, and the endoscopic transnasal approach for the resection of malignant tumors in this region is also uncommon. Clinical Presentation: We describe an esthesioneuroblastoma arising from the left maxillary sinus and PPF. The tumor was resected using the endoscopic transnasal approach, followed by treatment with radiotherapy. The patient showed no evidence of recurrence 12 months postoperatively. Technique: The endoscopic transnasal approach could be successfully used for the complete removal of malignant tumors in the PPF. Conclusion: The PPF is an anatomic area that is difficult to access. The endoscopic transnasal approach improves access and visualization; it also has the potential to reduce complications compared with the open approach. The endoscopic transnasal approach might become the treatment of choice for malignant tumors in the PPF.

Sign in / Sign up

Export Citation Format

Share Document