Infraorbital Neuralgia Research Articles

A rare variation of the infraorbital nerve, entrapping the infraorbital artery.

Anatomical variations are a common feature of the human anatomy. Variation can explain some pathological conditions and is important to keep them in mind during surgical procedures. The relations between nerves and their adjacent arteries have been proposed to play a role in the generation of peripheral trigger migraines. Close opposition between nerves and arteries can lead to vascular compression of the nerve that triggers episodes of pain. We did a routine dissection of the infratemporal fossa and orbital floor by opening the maxillary sinus. Here we report a case where the infraorbital nerves form a nervous loop entrapping the infraorbital artery in the infraorbital channel. Similar cases of close nervous and arterial apposition are described for the auriculotemporal and occipital nerves. We think that accumulating knowledge of these rare variations could expand our understanding of rare conditions such as primary infraorbital neuralgia.

Effectiveness and Safety of Radiofrequency Thermocoagulation Treatment Guided by Computed Tomography for Infraorbital Neuralgia Following Failed Conservative Treatment: A Retrospective Study.

To evaluate the effectiveness and safety of CT-guided radiofrequency thermocoagulation (RFT) for the treatment of infraorbital neuralgia following the failure of conservative management. This was a single center, retrospective study which included 196 patients between the ages of 37 to 90 years, who suffered from infraorbital neuralgia, and had undergone CT-guided RFT treatment. The medical records of these patients were retrieved between January 7, 2015 and February 5, 2020, and the patients were followed up for 2 years. Follow-up outcomes included Numerical Rating Scale (NRS) scores, dosage of carbamazepine, time to take effect, status of recurrence and side effects. The effective rate was defined as the percentage of patients with postoperative NRS score reduction of >50%. The effective rates were 92.9%, 100%, 100%, 100%, 93.4% and 85.7% onthesame day, week 1, month 1, month 6, year 1 and year 2 after RFT, respectively. After RFT, the postoperative NRS scores and dosage of carbamazepine were significantly reduced than those preoperatively (P < 0.05). The median time to take effect was zero day. Twenty-eight patients with recurrence underwent RFT again and achieved complete pain relief. All patients experienced numbness in the infraorbital nerve innervation area and the numbness scores gradually decreased over time. CT-guided RFT treatment may be an effective and safe technique for pain relief in patients with infraorbital neuralgia following failed results from conservative treatment.

&lt;p&gt;Introduction of pulsed radiofrequency cautery in infraorbital nerve block method for postoperative pain management of trauma-induced zygomaticomaxillary complex fracture reduction&lt;/p&gt;

Although various cases of neuralgia and its treatments have been reported, not enough evidence is present to recommend a single type of treatment as the most effective. The patient we have dealt with experienced significant interferences in his daily life due to chronic allodynia, but the symptom could not be resolved via previously reported treatments. We report a case of which a patient who presented infraorbital neuralgia after trauma was successfully treated by a novel treatment strategy. The patient was treated by applying infraorbital nerve block and pulsed radiofrequency cautery side by side. Through this report, we evaluate proper prevention and treatment strategies for patients who develop infraorbital neuralgia through similar etiologies.

The Effectiveness and Safety of 42°C Pulsed Radiofrequency Combined with 60°C Continuous Radiofrequency for Refractory Infraorbital Neuralgia: A Prospective Study

Background: Infraorbital neuralgia, one of the rare causes of facial pain, lacks systematic treatment guidelines because few studies on the topic have been published. We previously found that 42°C percutaneous nondestructive pulsed radiofrequency (PRF) treatment could achieve satisfactory pain relief for infraorbital neuralgia patients. However, patients who responded poorly to PRF had no other ideal treatment options until now. Recently, standard PRF combined with 60°C continuous radiofrequency (CRF) was successfully performed on trigeminal neuralgia patients and achieved a promising effective rate with mild complications. However, the efficacy of the combined therapy in the treatment of infraorbital neuralgia has not yet been reported. Objectives: To evaluate the effectiveness and safety of 42°C PRF combined with 60°C CRF in infraorbital neuralgia patients who responded poorly to 42°C PRF and were reluctant to receive destructive therapies or nerve decompression surgery. Study Design: Prospective, single-center, observational clinical trial. Setting: The interventional pain management center in Beijing Tiantan Hospital. Methods: We prospectively investigated the effects of 10 minutes of 3-dimensional computer tomography-guided 42°C PRF combined with 270 seconds of 60°C CRF in the treatment of 28 patients with refractory infraorbital neuralgia. The response criterion was a postoperative verbal pain numeric rating scale score reduction of &gt; 50%. The response rates at different time points during a 2-year follow-up were calculated. Results: The effective rates of combined PRF and CRF treatment were 95.5%, 86.4%, 81.8%, 72.7%, 72.7%, and 72.7% postoperative at 1 month, 3 months, 6 months, 1 year, 18 months, and 2 years, respectively. Except for 16 patients (72.7%) experiencing mild numbness that gradually disappeared within 1 week to 2 months after the operation, no obvious complications were observed. Limitations: This study examined the therapeutic effectiveness over a period of only 2 years; no further follow-up was conducted. In addition, this study is a single-center observational clinical study with small sample sizes. Conclusions: For patients with intractable infraorbital neuralgia, 42°C PRF combined with 60°C CRF is an effective and safe treatment. Prospective, double-blind randomized controlled trials with longer follow-up periods are needed to evaluate whether the combined treatment could become an alternative option for those who do not respond to conservative treatment, sparing those patients from destructive therapies or more invasive nerve decompression surgery. Key words: Infraorbital neuralgia, effectiveness, safety, pulsed radiofrequency, continuous radiofrequency, combined therapy

Effectiveness and Safety of Pulsed Radiofrequency Treatment Guided by Computed Tomography for Refractory Neuralgia of Infraorbital Nerve: A Pilot Study

Background: There is no truly optimal treatment to cure refractory neuralgia of the infraorbital nerve. Recently, nondestructive pulsed radiofrequency (PRF) has become one of the most attractive interventional techniques for painful disorders. However, use of the technique for infraorbital neuralgia has been seldom reported. Objective: The purpose of this prospective study is to observe the effectiveness and safety of PRF treatment for neuralgia of the infraorbital nerve. Study Design: Prospective case series clinical outcome study. Setting: University Medical Center, Beijing, China Methods: From January 2011 to November 2012, 36 consecutive patients, following ineffective conservative therapy, underwent PRF treatment and completed 2-year follow-up. Numeric rating scales (NRS), effective rate, additional carbamazepine dosage, and side effects were recorded at postoperative day one, week one, week 2, month one, month 3, month 6, year one, and year 2. Patients were divided into effective group and ineffective group based on postoperative one -month total pain relief or more than 50% reduction in NRS and patients were satisfied with the effect, and possible factors affecting efficacy were compared between the 2 groups. Results: Effective rates were 69%, 69%, 64%, 50%, and 50% at postoperative month one, month 3, month 6, year one, and year 2, respectively. No serious side effects were observed, except that 9 patients felt short-term (one -month duration) mild numbness. Output voltage and tissue resistance in the effective group were significantly higher than the ineffective group (P &lt; 0.01). Intraoperative output voltage was negatively correlated with postoperative one -month NRS (r = -0.332, P &lt; 0.05). Limitations: The non-controlled and single-centered design of the study. Conclusions: Results demonstrated PRF treatment under computed tomography (CT) guidance for infraorbital neuralgia is safe, effective, and is expected to become an alternative for patients experiencing ineffective conservative therapy. Increasing the output voltage of PRF could be the chosen method to improve the efficacy. Key words: Infraorbital nerve, neuralgia, pulsed radiofrequency, radiofrequency thermocoagulation

Lacrimal neuralgia: So far, a missing cranial neuralgia

The lacrimal nerve supplies the lacrimal gland, the lateral upper eyelid, and a small cutaneous area adjacent to the external CANTHUS . First division trigeminal neuralgia, supraorbital/supratrochlear neuralgia, and infraorbital neuralgia have been acknowledged as neuralgic causes of pain in the forehead and periorbit. However, the lacrimal nerve has never been identified as a source of facial pain. Here we report two cases of lacrimal neuralgia. A 66-year-old woman had continuous pain in the lateral aspect of her left superior eyelid and an adjacent area of the temple since age 64. A 33-year-old woman suffered from continuous pain in a small area next to the lateral CANTHUS of her left eye since age 25. In both patients the superoexternal edge of the orbit was tender. In addition, sensory dysfunction could be demonstrated within the painful area. Anaesthetic blockades of the lacrimal nerve with lidocaine 2% resulted in complete but short-lasting relief. Pregabalin provided a complete response in the first patient. The second patient was refractory to various oral and topical drugs and different radiofrequency procedures, but she eventually obtained partial relief with pregabalin. Lacrimal neuralgia should be considered among the neuralgic causes of orbital and periorbital pain.

Headache Management in an Interventional Pain Practice

More than 20 million people in the United States suffer from severe headaches. Most have been diagnosed as "migraines," which have been assumed to be an intracranial process. Recognition of the extracranial sources of headaches (such as supraorbital neuralgia, infraorbital neuralgia, auriculotemporal neuralgia, facial neuralgia, posterior auricular neuralgia, occipital neuralgia, cervical facet pathology, masseter spasm, sternocleidomastoid muscle spasm, trapezius spasm, and interspinous ligament pathology) has led to an expansion of the treatment options available for practitioners skilled in interventional pain procedures. However, unless the clinical presentation is recognized, treatment cannot be offered. Clinical presentation, diagnostic injections, differential diagnosis, and advanced neurolytic techniques are discussed in this article.

A CONSERVATIVE TREATMENT OF CHRONIC MAXILLARY SINUSITIS

The after-effects of the radical maxillary sinus operation may be serious. Anesthesia of the cheek may occur if the incision is extended too far toward the middle line, injuring the anterior dental nerve supply. Devitalization of the teeth may occur owing to nerve injury. Infra-orbital neuralgia results if the periosteum is elevated too high and the infra-orbital nerve injured. Aspiration pneumonia has been known to occur following general anesthesia. Therefore, I desire to make a plea for more conservative measures. If the after-effects of radical procedure can be eliminated by a more conservative method of treatment and the removal of pathologic tissue be obtained with less destruction of tissue, this method should be given consideration. The surgical treatment for chronic maxillary sinusitis may be considered radical or conservative, depending on the pathologic process found. Each case presents its characteristics, and treatment should be given to meet the requirements of

Notes from Manchester and London.

London, July, 1903. To the Editor: —Mr. George A. Wright, well known through his excellent work on early excision of the hip, is still active at the Royal Infirmary, Manchester, where the writer found him at work in the operating room. His first case was one of infraorbital neuralgia, which he treated by exposing the nerve and injecting into it a 2 per cent, solution of osmic acid; the results of this method, which does not abolish nerve function, are said to be very gratifying. In a case of extensive sinuses of the ilium, the opening was enlarged, and the sinus curetted and flushed out with turpentine, an application of which Mr. Wright thinks very highly. It is not painful, and does not interfere with primary union. The third operation was the opening of a pulmonary abscess in a young child. In conversation Mr. Wright said he was treating young