Infraorbital nerve transpositioning into orbital floor: a modified technique to minimize nerve injury following zygomaticomaxillary complex fractures

Abstract

ObjectivesTranspositioning of the inferior alveolar nerve to prevent injury in lower jaw has been advocated for orthognathic, pre-prosthetic and for implant placement procedures. However, the concept of infra-orbital nerve repositioning in cases of mid-face fractures remains unexplored. The infraorbital nerve may be involved in trauma to the zygomatic complex which often results in sensory disturbance of the area innervated by it. Ten patients with infraorbital nerve entrapment were treated in similar way at our maxillofacial surgery centre.Materials and MethodsIn this article we are reporting three cases of zygomatico-maxillary complex fracture in which intra-operative repositioning of infra-orbital nerve into the orbital floor was done. This was done to release the nerve from fractured segments and to reduce the postoperative neural complications, to gain better access to fracture site and ease in plate fixation. This procedure also decompresses the nerve which releases it off the soft tissue entrapment caused due to trauma and the organized clot at the fractured site.ResultsThere was no evidence of sensory disturbance during their three month follow-up in any of the patient.ConclusionInfraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve.

An Alternative Route for Entrapped Inferior Orbital Nerve in Orbital Floor Fracture

“…17 However, gingivobuccal sulcus incision is not sufficient in cases where the fracture is comminuted, involving the posterior floor of the orbit or in cases where the decompression of infraorbital nerve from the canal is planned as is in our case. 10,17,18 The graft used for repair of the floor of orbit is autologous membranous bone, Fig. 16 Early post-op.…”

“…Kotrashetti et al have described a modified technique to transpose infraorbital nerve into orbital floor, wherein they have approached the fracture through gingivobuccal sulcus incision while we have used subciliary and gingivobuccal sulcus incision for our surgical approach 17. However, gingivobuccal sulcus incision is not sufficient in cases where the fracture is comminuted, involving the posterior floor of the orbit or in cases where the decompression of infraorbital nerve from the canal is planned as is in our case 101718. The graft used for repair of the floor of orbit is autologous membranous bone, cartilage, iliac bone, split rib, or fascia lata.…”

“…Postoperatively, the patient was assessed and followed up for complications, but he had no complications (►Figs. [15][16][17]. The paresthesia due to the nerve injury resolved completely in 3 months (►Figs.…”

Sensitive nerve function measurement in facial trauma: An observational study

“…According to Burns et al ( 16 ), mandibular fractures can generate sensory alterations, whose clinical repercussions may be in the area of the mental nerve, promoting damage to patients. Similarly, lesions in the proximal maxillary bones or in the region of the infraorbital foramen, in which the infraorbital nerve emerges, lead to sensory alterations in the lower palpebral region, nose wing and upper lip ( 17 ).…”

The Infraorbital Foramen Is Located Midway Between the Nasospinale and Jugale: Considerations for Infraorbital Nerve Block and Maxillofacial Surgery

“…1 Also, the identification of the IOF is important for the prevention of iatrogenic injury of the infraorbital nerve in maxillofacial surgeries. 2–7…”