Accessory Nerves of the Forehead: A Newly Discovered Frontotemporal Neurovascular Bundle and Its Implications in the Treatment of Frontal Headache, Migraine Surgery, and Cosmetic Temple Filler Injection

Abstract

The identification and proper avulsion neurectomy of this newly described sensory FTN may lead to better surgical response rate during migraine surgery. In addition, this nerve should be considered during nerve block and botulinum toxin injections in migraine treatment. The existence of the accompanying vessel could have significant implications in the safety of filler and fat injections to this area.

Efficacy of Local Anesthesia in the Face and Scalp: A Prospective Trial

“…With the advent of new imaging technology and increased access to cadavers, our ability to accurately map out and understand facial anatomy has increased dramatically. 5 Based on facial anatomy, the authors of the present study postulate 3 anatomical differences between the facial regions that can help explain the difference in time to adequate anesthesia.…”

“…11 At this point, the supratrochlear nerve then ascends beneath the corrugator and the frontal belly of occipitofrontalis before dividing into branches that pierce these muscles to supply the skin of the lower forehead near the midline. 4,5 The supraorbital nerve pierces through mainly the supraorbital notch, in 90% of cases, and supplies palpebral filaments to the upper eyelid and conjunctiva. 4,12,16 It ascends on the forehead with the supraorbital artery and divides into medial (superficial) and lateral (deep) branches that supply the skin of the scalp as far back as the lambdoid suture.…”

“…4 Recently, with the advent of migraine surgery and improved techniques in facial reconstruction and rejuvenation, the trigeminal nerve has been extensively studied, yielding new branches and cutaneous nerves that were not previously identified, such as the accessory nerves of the forehead. 5 Through anatomical studies, it has been shown that the volume and quantity of main branches of the trigeminal nerve decrease in the cranial direction. 5,6 Building on this concept, when performing head and neck cutaneous cancer excisions, the authors of the present study noticed that lesions in the mid-forehead and scalp took significantly longer for the local anesthesia to take effect.…”

“…5 Through anatomical studies, it has been shown that the volume and quantity of main branches of the trigeminal nerve decrease in the cranial direction. 5,6 Building on this concept, when performing head and neck cutaneous cancer excisions, the authors of the present study noticed that lesions in the mid-forehead and scalp took significantly longer for the local anesthesia to take effect. The question became, why did lesions in this region take longer to achieve anesthesia?…”

Trigger-Site Deactivation Surgery for Nerve Compression Headaches

“…In approximately 55 percent of patients, an accessory frontotemporal nerve branch can be found exiting a foramen in the frontal bone on average 3.4 ± 0.47 cm superior to the lateral canthus. 95 This nerve branch should be explored. To protect the released the supraorbital and supratrochlear nerves, an adipose flap from the medial orbital fat pad can be wrapped around the nerves (Fig.…”