Abstract
Trauma to the supraorbital ridge is common and long-term sequalae of injury to the supraorbital and supratrochlea nerves is under-appreciated. Blunt trauma from motor vehicle accidents, sports injury, cosmetic surgery, and craniofacial surgery all represent potential sources of injury to these nerves, which are at risk as they traverse a path from intra-orbital to subcutaneous through a bony notch/foramen at the supraorbital ridge. Pain related to these nerves causes migraine headaches, dysesthesias in the forehead, and disability related to medication for chronic pain. A series of 5 patients are presented who represent post-traumatic pain related to these two nerves. Treatment strategies are reviewed. A new operative approach is described in which the proximal end of the supraorbital and the supratrochlear nerves are left within the orbit. Long-term follow-up documents no complications with regard to extraocular muscles and range of motion of the orbit, and significant relief of pain.
Highlights
Trauma to the supraorbital ridge is common and long-term sequalae of injury to the Supra Orbital (SO) and Supra Trochlear (ST) nerves is under-appreciated
Blunt trauma from motor vehicle accidents, sports injury, cosmetic surgery, and craniofacial surgery all represent potential sources of injury to these nerves, which are at risk as they traverse a path from intra-orbital to subcutaneous through a bony notch/foramen at the supraorbital ridge
While the anatomy of the SO and ST is well understood [1,2,3,4,5,6,7] management of neuromas of these nerves is poorly described. Pain related to these nerves causes migraine headaches [8,9] dysesthesias in the forehead, and disability related to medication for chronic pain
Summary
Trauma to the supraorbital ridge is common and long-term sequalae of injury to the Supra Orbital (SO) and Supra Trochlear (ST) nerves is under-appreciated. While the anatomy of the SO and ST is well understood [1,2,3,4,5,6,7] management of neuromas of these nerves is poorly described Pain related to these nerves causes migraine headaches [8,9] dysesthesias in the forehead, and disability related to medication for chronic pain. One report of treatment of a neuroma of these nerves has been published [12] The six patients in that series had the proximal nerve end connected to the other through a nerve conduit [12] This approach carries the risk of the “reconstructed” nerves forming a recurrent neuroma in the region of the supraorbital rim/ eyelid. The present series of patients had a different approach taken to treat their pain; the proximal end of the SO and ST nerves were resected so they lay deep within the orbit
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