Infraorbital Groove Research Articles

Orbital Hematoma Caused by Bleeding From Orbital Branch of the Infraorbital Artery After Reconstruction of an Orbital Fracture

We experienced and report on a case of retrobulbar hematoma caused by bleeding from the orbital branch of the infraorbital artery after a medial orbital wall reconstruction.A healthy 28-year-old man struck his left eye while playing baseball before admission. A computed tomographic scan revealed an approximately 13 × 12-mm-sized fracture of the left orbit medial wall. The medial orbit wall was reconstructed through a subciliary approach on the 18th day after the injury. Approximately 15 hours after the orbit wall reconstruction, the patient complained of pain in the left orbital area, headache, and vomiting. Upon an examination, swelling and ecchymosis were observed on the left eye. His visual acuity was 0.8 (oculus dexter [OD])/0.4 (oculus sinister [OS]) and the intraocular pressure was 18 (OD)/24 (OS) mm Hg by a Goldmann applanation tonometry. A computed tomographic scan showed an intraorbital hematoma and proptosis on the left side. In an emergency operation, a hematoma with a volume of approximately 2 to 3 mL was evacuated and an active bleeding point was noted on the orbital floor, which was thought to be the orbital branch of the infraorbital nerve. The bleeding point was cauterized. After the operation, his visual acuity was 1.0 (OD)/0.8 (OS) and the ocular pressure normalized to 16 (OD)/16 (OS) mm Hg by a Goldmann applanation tonometry.Close observation and meticulous hemostasis along the infraorbital groove may be needed in an orbital floor exploration to prevent postoperative orbital hematoma.

Variations in the topography of the infraorbital canal/groove complex: a proposal for classification and its potential usefulness in orbital floor surgery

The aim of the study was to precisely describe and classify the infraorbital canal/groove (IOC/G) complex in dry human skulls and to evaluate the presence of asymmetry in the IOC/G complex. Seventy orbits of 35 human skulls were investigated.The following distances were measured: the distance between the posterior and anterior margin of the infraorbital groove (S-C); the posterior margin of the infraorbital canal and the infraorbital foramen (C-IOF); and the total length of the infraorbital canal-groove complex (S-C-IOF). The symmetry of the contralateral measurements was analysed. Three types of the IOC/G complex were distinguished: types I, II, III, whose respective incidences were 11.4%, 68.6%, 20.0%. The mean length of the infraorbital groove plus canal complex on the right and left with standard deviation were 27.78±3.69 mm and 28.06±3.37 mm, respectively. The results presented in this study may be particularly helpful for surgery in patients with blow-out fractures and different endoscopic and reconstructive procedures in the region of the inferior orbital wall. The type III IOC/G complex, according to our classification, seems the most likely to be exposed to trauma during surgical manipulations.

Comparative Morphology of Premolar Foramen in Lagomorphs (Mammalia: Glires) and Its Functional and Phylogenetic Implications

Lagomorphs (a group that consists of pikas, hares, rabbits and allies) are notable for their conservative morphology retained for most of their over 50 million years evolutionary history. On the other hand, their remarkable morphological uniformity partly stems from a considerable number of homoplasies in cranial and dental structures that hamper phylogenetic analyses. The premolar foramen, an opening in the palate of lagomorphs, has been characterized as an important synapomorphy of one clade, Ochotonidae (pikas). Within Lagomorpha, however, its phylogenetic distribution is much wider, the foramen being present not only in all ochotonids but also in leporids and stem taxa; its morphology and incidence also varies considerably across the order, even intraspecifically. In this study, we provide a broad survey of the taxonomic distribution of the premolar foramen in extant and fossil Lagomorpha and describe in detail the morphological variation of this character within the group. Micro-computed tomography was used to examine the hard palate and infraorbital groove morphology in Poelagus (Leporidae) and Ochotona. Scans revealed the course and contacts of the canal behind the premolar foramen and structural differences between the two crown clades. We propose that the premolar foramen has evolved independently in several lineages of Lagomorpha, and we discuss development and function of this foramen in the lagomorph skull. This study shows the importance of comprehensive studies on phylogenetically informative non-dental characters in Lagomorpha.

Orbital floor restoration with traction of the infraorbital nerve using a vessel loop in posterior orbital floor fractures

BackgroundThe authors retracted the infraorbital nerve (ION) using a vessel loop to explore the orbital floor fracture site and analysed when the traction of the ION was needed. MethodsIn ninety-one patients, the location of the fracture according to its position relative to the infraorbital groove, the location of the infraorbital groove from the midpoint of the orbital floor, and involvement of the ION in the fracture site were recorded retrospectively from computed tomography scans. An analysis of any associations between the traction of ION and the location of the fracture and ION passage was performed. ResultsTraction of the ION was performed in 14 cases, of which 10 cases had involvement of the ION in the fracture site and 4 cases did not. All of them were posterior fractures. In 51 cases with posterior fractures, the ION passage in patients who had ION traction was statistically located more medially (0.50 ± 1.19 mm) than in patients who had no traction (2.38 ± 1.12 mm) (p < 0.05). ConclusionThe ION may interfere with the exposure of the fracture site in a posterior orbital floor fracture with the involvement of the ION in the fracture site and a medially located ION passage.

Morphometric analysis of the infraorbital groove, canal, and foramen on three-dimensional reconstruction of computed tomography scans

This study aimed to investigate the anatomy of the infraorbital foramen (IOF), infraorbital canal (IOC), and infraorbital groove (IOG) with regard to surgical and invasive procedures using three-dimensional reconstruction of CT scans. The CT scans of 100 patients were evaluated retrospectively. The morphology of the IOF, IOC, and IOG as well as their relationships to different anatomic landmarks was assessed in a three-dimensional model. The mean length of the IOC and IOG and the angle of the IOC relative to IOG were 11.7 ± 1.9, 16.7 ± 2.4 mm, and 145.5° ± 8.5°, respectively. The mean angles of the IOC relative to vertical and horizontal planes were 13.2° ± 6.4° and 46.7° ± 7.6°, respectively. In the relationships between the IOF and different anatomic landmarks, the mean distances from the IOF to supraorbital notch/foramen, facial midline, and infraorbital rim were 5.6 ± 3.1 mm laterally, 26.5 ± 1.9 mm laterally, and 9.6 ± 1.7 mm inferiorly, respectively. The mean distance from the IOF to anterior nasal spine (ANS) was 35.0 ± 2.6 mm, and the mean angle of the axis that passed the IOF and ANS relative to horizontal plane was 28.8° ± 4.1°. In addition, the mean soft tissue thickness overlying the IOF was 11.4 ± 1.9 mm. These results provide detailed knowledge of the anatomical characteristics and clinical importance of the IOF. Such knowledge is of paramount importance for surgeons when performing maxillofacial surgery and regional block anesthesia.

The application of undermining orbicularis oculi muscle from orbital rim for the correction of tear trough deformity and palabromalar groove in lower blepharoplasty

To evaluate the role of undermining orbicularis oculi muscle from Orbital rim for the correction of tear trough deformity and palabromalar groove in lower blepharoplasty. 56 cases of lower eye baggy deformity with tear trough deformity and palabromalar groove were treated with the procedure of stripping eye orbicularis oculi muscle from orbital rim by a transcutaneous approach in lower blepharoplasty. The orbital septum was opened along the arcus marginalis for releasing the orbital fat. Some orbital fat was removed if necessary. Then the inferior edge of the orbital septum fat was reset over the orbital rim so as to smooth the infraorbital groove. 56 patients were available for 6 to 18 month's follow-up. 54 patients were quite satisfied with the cosmetic result. One developed lower eyelid retraction and another one showed asymmetrical subcutaneous local uneven after 1 month's. They were all corrected by the second operation after 3 months. Stripping orbicularis oculi muscle from orbital rim plays an important role for the correction of tear trough deformity and palabromalar groove in lower blepharoplasty.

Morphometric and Geometric Anatomy of the Caucasian Orbital Floor

Introduction: To describe the morphometric and geometric relationships of the orbital floor in a Caucasian population.Materials and Methods: Exenterations of 47 orbits from 24 formalin fixed cadavers were performed. Morphometric measurements were taken between anatomical landmarks located along the orbital floor and the orbital apex. The mean measurements were used to calculate geometric data. These results were analysed according to sex and side and compared to results from other ethnic populations.Results: The average distances from the infraorbital foramen to the nasolacrimal fossa, inferior orbital fissure, optic canal and inferior orbital rim were 20.67 mm (± 2.42), 25.40 mm (±2.70), 43.23 mm (±3.35) and 8.95 mm (± 1.53), respectively. The average distances from the tip of the infraorbital groove to the tip of the inferior orbital fissure, lateral aspect of the inferomedial strut, optic canal and the intersection with the inferior orbital fissure were 14.08 mm (±2.41), 12.12 mm (±2.42), 35.02 mm (±3.17) and 20.05 mm (± 2.87), respectively. The distances from the tip of the inferior orbital fissure to the optic canal and the intersection with the inferior orbital groove were 29.56 mm (±2.73) and 13.37 mm (±2.76), respectively.Discussion: Orbital surgeons should be aware of the morphometric relationships of the orbital floor due to the degree of variation that exists between different ethnic groups. Geometric data may be used to provide orbital surgeons with a navigational template that can be used to plan surgery and as a guide intraoperatively.

Fetal valproate syndrome in a 2-month-old male infant

Fetal valproate syndrome (FVS) results from prenatal exposure to valproic acid. It is characterized by a distinctive facial appearance, a cluster of minor and major anomalies and central nervous system dysfunction. We describe a 2-month-old male infant with the typical dysmorphic features characteristic of FVS. He had a persistent left superior vena cava draining into a dilated coronary sinus and mild pulmonary hypertension. There was a history of maternal intake of sodium valproate during pregnancy.

Do We Have to Dissect Infraorbital Nerve From Periorbita in Orbital Floor Fracture?

The aim if this study was to see whether we have to dissect the infraorbital nerve from periorbita in orbital floor fractures.Orbital floors were reconstructed in 174 patients. Among them, 31 patients were treated with horseshoe-shaped synthetic sheets. Preoperative and postoperative findings including hypesthesia, diplopia, Hertel exophthalmometry, and occurrence of complications were checked.After the subciliary incision through skin and orbicularis oculi muscle, the skin-muscle flap was elevated just superficial to the orbital septum to the arcus marginalis. The periosteum was incised and elevated to expose the fracture site. The orbital branch of the infraorbital artery was identified. The periorbita was not separated from the infraorbital nerve, and the orbital branch of the infraorbital artery was preserved. The sheet was trimmed in horseshoe shape as the cleft fits to the infraorbital groove.On physical examination before surgery, diplopia was the most common (58.1%) associated complication, followed by hypesthesia (35.5%), limited ocular movement (9.7%), enophthalmos (3.2%), and hematoma (3.2%).Even if the fracture site is the posterior half, the periorbita does not have to be separated from the infraorbital nerve to avoid injury of the orbital branch of the infraorbital artery. Instead, the fracture site might be covered by a horseshoe-shaped sheet.

ANATOMIC STUDY OF THE INFRAORBITAL FORAMEN FOR RADIOFREQUENCY NEUROTOMY OF THE INFRAORBITAL NERVE

To examine the anatomy of the infraorbital canal and foramen and the angles at which a radiofrequency probe must be directed to enter the infraorbital foramen and canal, as a guide to performing radiofrequency ablation of the infraorbital nerve in patients with relative or absolute contraindications to lesions of the trigeminal ganglion or posterior root. Eleven cadaveric skulls were studied. The infraorbital nerve, after passing through the infraorbital foramen, enters the infraorbital canal and groove in the floor of the orbit before reaching the foramen rotundum. Small probes were placed through the foramen into the infraorbital canal, and pictures were taken in the anteroposterior and sagittal planes. The pictures were analyzed using the ImageTool program (University of Texas Health Science Center, San Antonio, TX) to calculate the anteroposterior and sagittal angles of the probe. The distances of the foramen from the midline, lateral edge of the anterior nasal aperture, and inferior orbital rim were examined. A probe introduced through the cheek from below and medial to the foramen and directed upward and laterally at an angle of approximately 22 degrees in the coronal plane and 120 degrees in the sagittal plane toward a point approximately 26 mm from the midline and 8 mm below the inferior orbital rim will penetrate the infraorbital foramen for placement of the probe's tip in the infraorbital canal. The coordinates for placement of the radiofrequency probe through the infraorbital foramen and into the infraorbital canal are reviewed, along with a discussion of pitfalls in radiofrequency ablation of the nerve.

Orbitofacial Cleft Number 5: Radiographic, Anatomical, and Histologic Study of a 24-Week-Old Fetus

Orbitofacial clefts are caused by a congenital absence of midfacial tissues between the eye and the upper lip just medial to the corner of the mouth. As a whole, facial clefts occur with an incidence of 1.43 to 4.85 per 100,000 births. The exact incidence of these unusual orbital facial clefts is unknown. Only a few clinical cases and their treatment have been reported in the world literature, and no anatomical or histologic study has been presented. The authors present a detailed anatomical and histologic study in a 24-week-old fetus with a right-side no. 5 orbitofacial cleft (according to Tessier's classification). During the anatomical dissection, it was observed that in the trigeminal Gasser ganglion on the right side there was no infraorbital branch of this nerve. Both the foramen rotundum and the infraorbital groove, where the nerve exits, were hypotrophic. After embryologic analysis of their observation, the authors propose that the orbitofacial no. 5 cleft should be considered as a tissular disruption of the face secondary to damage of the terminal branches of the maxillary nerve.

Strangulated Trapdoor Type Orbital Blow-out Fractures in Children: Fracture Pattern and Clinical Outcome

We report four typical cases of a strangulated trapdoor type, blow-out fracture of the orbital floor in children under the age of 10 years. Diplopia and restricted eye movement were observed soon after the accident, and surgical interventions were performed approximately within 2 weeks from the impact in all four cases. Close intraoperative observations revealed all the fractures to be trapdoor-like, with the “hinge” located medially and the “door” bounded by a bony defect of a few millimetres wide along the infraorbital groove and two fracture lines in a coronal direction running from the groove, perpendicularly and medially. Furthermore, we found strangulation of soft tissue in the fracture line along the infraorbital groove. We believe that this type of fracture occurs due to the premature development of the orbit in children. All children were surgically treated with release of the trapped orbital tissue, but recovery of ocular movement required 2 to 3 months. Consensus has it that early operation is favourable for this type of fracture. However our cases show that favourable results can be attained by operation done even after 2 weeks. Understanding of the bony structure and the fracture pattern of the orbit in children will help in the accurate imaging diagnosis and selection of operative procedures.

Strangulated trapdoor type orbital blow-out fractures in children. Fracture pattern and clinical outcome

We report four typical cases of a strangulated trapdoor type, blow-out fracture of the orbital floor in children under the age of 10 years. Diplopia and restricted eye movement were observed soon after the accident, and surgical interventions were performed approximately within 2 weeks from the impact in all four cases. Close intraoperative observations revealed all the fractures to be trapdoor-like, with the “hinge” located medially and the “door” bounded by a bony defect of a few millimetres wide along the infraorbital groove and two fracture lines in a coronal direction running from the groove, perpendicularly and medially. Furthermore, we found strangulation of soft tissue in the fracture line along the infraorbital groove. We believe that this type of fracture occurs due to the premature development of the orbit in children. All children were surgically treated with release of the trapped orbital tissue, but recovery of ocular movement required 2 to 3 months. Consensus has it that early operation is favourable for this type of fracture. However our cases show that favourable results can be attained by operation done even after 2 weeks. Understanding of the bony structure and the fracture pattern of the orbit in children will help in the accurate imaging diagnosis and selection of operative procedures.

Certain anatomical relations and the precise morphometry of the infraorbital foramen--canal and groove: an anatomical and cephalometric study.

To determine and to standardize the certain anatomical relations, and the precise size, course, and location of the infraorbital foramen, canal, and groove for facilitating surgical and invasive procedures. This anatomical study consisted of two main steps, namely, the examination of skulls and the cephalometric analysis of the skulls. Measurements of the skulls and of the radiograms were performed. Thirty-five adult bony heads (70 sides) were studied regarding the localization and dimensions of the infraorbital groove (IOG), infraorbital canal (IOC), and infraorbital foramen (IOF) as well as their relationships with different anatomical landmarks. The cephalometric analysis of the skulls was measured for evaluating the relationships of certain anatomical points and the distances of the skulls in the cephalometric analysis. For this purpose, 13 different distances and two angles were measured on anteroposterior and lateral craniographies. Differences between data of skull and cephalogram measurements were analyzed by the Student t test. The Pearson correlation test was used in the statistical analysis of the 15 values in the cephalogram. Examination of the 70 sides of the 35 bony heads revealed that the shape of the IOF was oval in 34.3%, round in 38.6%, and semilunar in 27.1% of all skulls. The IOF was single in 94.3% and double in 5.7% of the cases. The average distance from the IOF to the infraorbital margin and to the lateral process of the canine tooth in vertical direction and to the lateral nasal border in horizontal direction were 7.19 +/- 1.39 mm, 33.94 +/- 3.15, and 17.23 +/- 2.64 mm, respectively. In cephalometric analysis, when S-N (the distance between the center of the sella turcica and the nasion) and N-ANS (the distance between the nasion and the anterior nasal spine) distances were used as independent parameters for the linear analysis, the correlation of the three values for both independent parameters were statistically significant. While the IOF has no statistically significant changes with regard to the size of the skull, expressive changes take place in the course and the length of the IOG and IOC. Meticulous preoperative evaluation of the IOF and the route of the infraorbital nerve are necessary in patients who are candidates for maxillofacial surgery and regional block anesthesia. If these measurements are taken into account, there will be little surgical risk, and this will be helpful in identifying the extent of the operative field.

Surgical anatomy of the orbit of Korean adults.

When operating in and around the orbit, the key to a successful result is precise anatomical localization. However, there is no precise study about the localization of vital orbital structures from reliable periorbital bony anatomy of the Korean adult. This study was constructed to give pertinent anatomical measurements to which the plastic and maxillofacial surgeon may refer. The 82 orbits obtained from 41 skulls of adult Koreans were measured with Vernier calipers and Marshac calipers. Superiorly, the supraorbital fissure was 40.0 +/- 2.5 mm from the supraorbital notch. Medially, the posterior ethmoidal foramen was 31.7 +/- 3.0 mm from the anterior lacrimal crest. Inferiorly, the infraorbital fissure where the infraorbital groove started was 26.4 +/- 2.6 mm from the infraorbital foramen. Laterally, the supraorbital fissure was 34.3 +/- 2.7 mm from the frontozygomatic suture. These distances are suggested as appropriate safe distances from each periorbital bony landmark. Dissection beyond that distance should be done with great caution.

Le développement post-natal et les rapports du sinus maxillaire

In children, the maxillary sinus is pyramidal in shape. The apex of the pyramid looks forward, and the base looks backwards. The maxillary sinus has three walls--the superior, the medial and the inferior. The superior wall establishes a relationship with the infraorbital groove and the infraorbital canal during the 4th year. During the first months of life, the maxillary sinus has no relationships with the inferior nasal meatus. At about 6th year, the maxillary sinus is at the height of the floor of the nasal cavity and thus a close relationship is established with the inferior nasal meatus.

Increase in Orbital Volume Obtained by Decompression in Dried Skulls

We totally or partially removed the medial wall, floor, lateral wall, or a combination of the three, in four orbits and measured the increased orbital volume that results from the more common orbital decompression techniques. Removal of medial wall alone added 6 cc of volume to the orbit. Removing the floor of the orbit while preserving bone lateral to the infraorbital groove added 7 cc of volume. Removing the lateral floor added 1 cc and removing the lateral wall added 2 cc. Effective lateral decompression, therefore, requires creation of space within the temporal fossa. Removing the wall and the medial floor together added 13 and 14 cc of volume in two separate skulls. The largest volume gained by orbital decompression was 15 cc. This occurred when the entire orbital floor and medial wall were removed. Little volume is lost, however, when the lateral floor is preserved.

Post-traumatic infra-orbital neuropathy: Another entrapment syndrome

its entrance in the anterior portion of the bony orbit and is 1.0-1.5 cm in length. The roof and floor of the canal are extremely thin and easily damaged. The nerve exits from the recessed infra-orbital foramen in the company of the infra-orbital artery and vein (which enters the canal at this point). The nerve is enclosed in a fibrous tube which is readily demonstrated during any operation on the anterior face of the maxilla but particularly during the preliminary steps of the Caldwell-Luc operation, when it may be injured by retraction. The nerve breaks up into a number of branches, which radiate widely over the mid-face. The superior fibres (palpebral branches) innervate the skin of the lower eyelid and the palpebral conjunctiva. Labial branches innervate the skin and mucous membrane of the upper lip and the adjacent alveolar mucosa from the mid-line to the region of the maxillary premolar teeth. The nasal branches innervate the skin of the lateral aspect of the nose. The middle superior dental nerves are (when present) given off in the infra-orbital groove and the anterior superior dental nerves arise in the canal to innervate the maxillary incisor and canine teeth, the adjacent antral mucosa and the anterior inferior quadrant of the nasal

Spatial aspects of the orbital muscle.

The spatial aspects of the orbital muscle of Muller were studied in serial sections of human embryos and foetuses (30 to 155 mm C-RL), and five adult human heads were examined with a binocular dissection microscope. A cardboard reconstruction of the left orbit with the orbital muscle and its related structures was made of a 155 mm C-RL foetus. In all specimens we found extensive contact between the orbital muscle and the cavernous sinus. In this area the muscle has no contact with the sphenoid or the annulus of Zinn. The spatial consequence of this configuration is that passage from the xterygo-palatine fossa to the retro-orbital region is possible without perforation of the orbital muscle. This specific course is used by some rami orbitales to join, for instance, the abducent and frontal nerves, and is also taken by some small veins. Parts of the orbital muscle, also called fascicles, have an unmistakable spatial function. The frontal extension of the orbital muscle on the floor of the orbit covers the infra-orbital groove, and the fronto-caudal extension in the infratemporal fossa closes off the fronto-lateral part of the inferior orbital fissure.