Concept: Supraorbital nerve
Migraine is included in the top-ten disabling diseases and conditions among the Western populations. Non-invasive neurostimulation, including the Cefaly® device, for the treatment of various types of pain is a relatively new field of interest. The aim of the present study was to explore the clinical experience with Cefaly® in a cohort of migraine patients previously refractory or intolerant to topiramate prophylaxis.
Transcutaneous supraorbital nerve stimulation (tSNS) with the Cefaly® device was recently found superior to sham stimulation for episodic migraine prevention in a randomized trial. Its safety and efficiency in larger cohorts of headache sufferers in the general population remain to be determined.The objective of this study was to assess the satisfaction with the Cefaly® device in 2,313 headache sufferers who rented the device for a 40-day trial period via Internet.
Subbrow blepharoplasty (SBB) addresses lateral hooding of the upper eyelid skin, a shortcoming of classical upper blepharoplasty. Therefore, SBB is widely used by plastic surgeons in Korea and Japan. The aim of this study is to improve postoperative results and to minimize a relapse of existing SBB by the use of a supraorbital rim periosteal suture fixation technique.
The aim of this study was to introduce a technique of dividing forehead depressor muscles with a subbrow excision for improvement of brow ptosis or redundant upper eyelid skin and glabella wrinkles. Upper incisions were designed at the lower limit of the eyebrow with a lateral extension along the eyebrow curvature. After measuring the redundant upper eyelid skin, the excess skin was excised. The orbital part of the orbicularis oculi muscle was identified and split longitudinally. The forehead depressor muscles (depressor supercilii, oblique and transverse head of corrugator, and medial part of orbicularis oculi) in the brow fat pad were identified and avulsed. In the patients who have a lowered brow, the brow was elevated and fixed to the underlying periosteum about 1 cm above the superior orbital rim after subgaleal dissection. During the dissection, the supraorbital nerve was preserved. Preaponeurotic fat was transferred and sutured between the cut stumps of the corrugator and procerus. The 78 patients (19 men, 60 women; age range, 41-72 years [mean, 52.0 ± 7.1 years]) were operated on. The follow-up periods ranged from 3 to 48 months. Preoperative and postoperative photographs were taken, and the following evaluations were conducted by 1 surgeon via a Likert scale (1 = not improved, 2 = slightly improved, 3 = somewhat improved, 4 = much improved, 5 = markedly improved). The mean score for improvement of the glabella frowns in contraction was 3.7 ± 1.6. The mean score for the improvement of the glabella frowns in relaxation was 4.1 ± 1.3. The mean score for improvement of drooping eyelids was 4.7 ± 0.5. The mean score for the improvement of forehead wrinkles was 4.8 ± 0.7. We improved brow ptosis, redundant upper eyelid skin, and glabella wrinkles simultaneously using a subbrow excision and depressor muscle division while preserving the superficial branch of the supraorbital nerve.
The aim of this study was to elucidate the sensory territory of the trigeminal nerve on the upper eyelid.Eight hemifaces from Korean cadavers were dissected. The frontal nerve (FN), supraorbital nerve (SON), supratrochlear nerve (STN), infratrochlear nerve (ITN), and lacrimal nerve (LN) were traced.The terminal branches to the eyelid margin of FN were distributed between 1/6 and 2/5 of the palpebral fissure width lateral to the medial canthus and 1/6 of the eyebrow height from eyelid margin. The SON was distributed between 2/5 and 9/10 of the eye width lateral to the medial canthus, at 1/3 of the eyebrow height. The STN was distributed between -¼ and -1/5 of the eye width medial to the medial canthus, at 1/5 of the eyebrow height. The ITN was distributed at -¼ and 1/10 of the eye width medial to the medial canthus, and at 1/5 of the eyebrow height. The LN was distributed between approximately 3/5 and 13/10 of the eye width lateral to the medial canthus, and at ¼ of the eyebrow height. The main branches of FN and SON ran deep to the orbicularis from the supraorbital notch to the upper border of the tarsal plate. In the pretarsal area, they were between the orbicularis and tarsal plate. The STN and ITN were between the orbicularis and the skin. The LN was observed between the orbicularis and the tarsal plate.Upper eyelid was mainly supplied by SON and FN. The medial extremity was supplied by STN and ITN, and the lateral extremity by LN.
- Pain practice : the official journal of World Institute of Pain
- Published 12 months ago
No ideal therapeutic method currently exists for refractory idiopathic supraorbital neuralgia patients who don’t respond to conservative therapy, including medications and nerve blocks. Pulsed radiofrequency is a neuromodulation technique that does not produce sequelae of nerve damage after treatment. However, the efficacy of percutaneous pulsed radiofrequency for the treatment of refractory idiopathic supraorbital neuralgia is still not clear. The purpose of our study was to evaluate the efficacy and safety of pulsed radiofrequency treatment of the supraorbital nerve for refractory supraorbital neuralgia patients.
A 35-year-old male patient was presented with pain on his right upper eyelid. A piece of wood injured his orbital and supraorbital regions while working at a furniture factory 10 days prior to our hospital admission. It was learned that the patient was discharged following the primary would closure procedure. Subsequent to the craniofacial computed tomography, primary wound closure was performed in the emergency room of previous hospital. In our clinic, a skin suturing on the nasal side of the right eyebrow was inspected and a foreign body (FB) was palpated on the superonasal contiguity of the patients' right globe. A hyperdense FB measuring 30 × 10 × 5 mm in size with smooth margins on superonasal contour of the globe was detected. Superonasal orbitotomy was performed and the FB was completely removed. Finally, visual acuity was 20/20 and a mild residual ptosis was observed.
Meningiomas of the clinoid region pose formidable surgical challenge. Pterional craniotomy is the traditional approach, and often associated with high-risk post-surgical morbidities. In the current presentation, we describe an elderly male with a clinoidal meningioma that underwent a minimally invasive supra-orbital craniotomy for tumor resection. Patient presentation, neuroimaging, and surgical techniques (patient position, incision, anatomical consideration, and surgical steps) are described meticulously. Initial intraoperative steps include dissection via the corridor between the carotid artery and the tentorium, and exposing the tumor in the optico-carotid triangle, followed by tumor dissection using microsurgical techniques. Care must be taken to preserve the supraorbital nerve to prevent frontal numbness, and to avoid violation of the frontal sinus to prevent postoperative cerebrospinal fluid leak. Emphasis on using this minimally invasive procedure for clinoidal meningiomas over pterional approach for select cohort of patients is laid, considering the cosmetic merits and adequate extent of tumor resection.
Paranasal sinus mucoceles are benign lesions that commonly present with orbital signs due to their anatomic proximity. We are reporting a case of bilateral frontal sinus mucocele presenting with spontaneous eyelid ecchymosis. To our knowledge this is the first case report of eyelid ecchymosis as the initial sign of this condition. In addition, our patient lacked commonly described symptoms such as diplopia or pain. This report highlights the importance of including frontal sinus mucocele in the differential diagnosis of spontaneous periorbital ecchymosis.
To elucidate the course of the supraorbital nerve (SON) with reference to the lacrimal caruncle in order to facilitate safer direct browplasty by preventing nerve injury.