Standardized Centella asiatica extract ECa 233 alleviates pain hypersensitivity by modulating P2X3 in trigeminal neuropathic pain

Abstract During oral surgery and temporomandibular joint repositioning, pain hypersensitivity often occurs due to irritation or inflammation of the nerve endings in the orofacial region. Objective: This study aimed to investigate the effects of ECa 233, a Centella asiatica-standardized extract, on the development of mechanical hyperalgesia and allodynia induced by chronic constriction injury of the infraorbital nerve in mice. Methodology: The right infraorbital nerves of the mice were ligated. Oral carbamazepine (20 mg/kg) or ECa 233 (30, 100, or 300 mg/kg) was administered daily for 21 days. Von Frey and air-puff tests were performed on both sides of the whisker pad on days 0, 7, 14, and 21. Thereafter, the expression of purinergic receptor subtype 3 (P2X3) and voltage-gated sodium channel 1.7 (NaV1.7), a transmembrane protein, in the trigeminal ganglion and c-fos immunoreactivity-positive neurons in the trigeminal nucleus caudalis was assessed. Results: After 21 days of infraorbital nerve ligation, the mice showed allodynia- and hyperalgesia-like behavior, P2X3 and NaV1.7 were upregulated in the trigeminal ganglion, and nociceptive activity increased in the trigeminal nucleus caudalis. However, the oral administration of carbamazepine (20 mg/kg), ECa 233 (100 mg/kg), or ECa 233 (300 mg/kg) mitigated these effects. Nevertheless, ECa 233 failed to affect NaV1.7 protein expression. Conclusion: Carbamazepine and ECa 233 can prevent pain hypersensitivity in mice. Considering the side effects of the long-term use of carbamazepine, ECa 233 monotherapy or combined ECa 233 and carbamazepine therapy can be used as an alternative for regulating the development of hypersensitivity in trigeminal pain. However, further detailed clinical studies should be conducted to provide comprehensive information on the use of ECa 233.

Treatment of infraorbital nerve injury after orbital fracture with Triamcinolone acetonide combined with rat nerve growth factor / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical efficacy of local application of triamcinolone acetonide combined with mouse nerve growth factor in the treatment of infraorbital nerve injury after infraorbital wall fracture.METHODS: Forty-three patients(43 eyes)with infraorbital wall fractures who underwent infraorbital wall fracture revision from April 2020 to February 2021 at the Affiliated Eye Hospital of Nanchang University were prospectively analyzed. Patients were randomly divided into two groups, in which 20 patients(20 eyes)in the experimental group had gelatin sponges infiltrated with triamcinolone acetonide and mouse nerve growth factor placed on the nerve injury intraoperatively; 23 patients(23 eyes)in the control group had no special treatment intraoperatively. At 6mo postoperative follow-up, the results of quantitative sensory testing(two-point localization, nociception, and touch)were compared between the affected and healthy lower lid areas, and the results were reported in an asymmetry index(AI).RESULTS: Baseline results showed no significant differences between the two groups in terms of gender, age, time of injury, and preoperative sensory testing between the two groups(all <i>P</i>>0.05). The AI values of two-point localization sensation, tactile sensation, and pain sensation in both groups were higher at 1wk after surgery than before surgery(all <i>P</i><0.05), and the symptoms of sensory impairment were aggravated, with different degrees of improvement at 1mo after surgery and statistically significant differences in pain sensation at 3mo after surgery(<i>P</i><0.05), and two-point localization sensation, tactile sensation, and pain sensation were significantly improved at 6mo after surgery than before treatment(all <i>P</i><0.01). At 1mo after surgery, the differences in two-point localization sensation and pain sensation in the test group were statistically significant compared with the control group(<i>t</i>=-2.082,-2.143; <i>P</i>=0.044, 0.038). At 3mo after surgery, there was a statistically significant difference in nociception in the test group compared to the control group(<i>t</i>=-2.118, <i>P</i>=0.04). At 6mo after surgery, there was no statistically significant difference in quantitative sensory testing between the two groups(<i>P </i>>0.05).CONCLUSION: Local application of triamcinolone acetonide combined with mouse nerve growth factor for the treatment of infraorbital nerve injury after infraorbital wall fracture was effective in early internal recovery and superior to the group without special intraoperative treatment.

Morphometric analysis of infraorbital foramen using cone beam computed tomography in a cohort of Sri Lankan adults / Análisis morfométrico del foramen infraorbitario mediante tomografía computarizada de haz cónico en una cohorte de adultos de Sri Lanka

SUMMARY: Infraorbital foramen (IOF) located bilaterally within the maxillary bone about 1 cm inferior to the infraorbital margin is a vital landmark when delivering local anesthesia and during surgical interventions in the midface region. A total of 122 infraorbital foramina in 61 cone beam computed tomographic (CBCT) images of 32 females and 29 males in the age range of 17 to 32 were analyzed to determine the shape, direction, presence of accessory foramina, size and the precise position of IOF in relation to the inferior orbital margin (IOM), maxillary midline (MM), lateral nasal wall (LNW), alveolus (ALV) and maxillary teeth in a group of Sri Lankan people. The IOF was oval in shape (80.3 % and 88.5 % on the right and left side, respectively) in a majority of individuals. The infraorbital foramina were located at a mean distance of 5.56 ± 3.95 and 4.91 ± 2.08 mm, below the IOM on the right and left side, 27.13 ± 2.6 and 26.99 ± 2.73 on the right and left side from the mid maxillary line, 11.96 ± 3.45 mm and 12.18 ± 3.35 from the LNW on the right and left side and 29.59 ± 3.59 and 29.65 ± 3.28 above the alveolar crest on the right and left side. There were no statistically significant differences between the left and right sides or between sexes. Majority of IOF (37.5 % and 55.9 % on the right and left side, respectively) were located in the vertical plane passing though the maxillary second premolar tooth.

RESUMEN: El foramen infraorbitario (FIO) ubicado bilateralmente dentro de la maxila, aproximadamente 1 cm inferior al margen infraorbitario, es un punto de referencia vital cuando se administra anestesia local y durante intervenciones quirúrgicas en la región media de la cara. Se analizaron un total de 122 forámenes infraorbitarios en 61 imágenes de tomografía computarizada de haz cónico (CBCT) de 32 mujeres y 29 hombres en un rango etario de 17 a 32 años para determinar la forma, dirección, presencia de forámenes accesorios, tamaño y posición precisa de FIO en relación con el mar- gen orbitario inferior (MOI), la línea mediana maxilar (MM), la pared nasal lateral (PNL), el alvéolo (ALV) y los dientes maxilares en un grupo de personas de Sri Lanka. En la mayoría de los adultos se observó que el FIO tenía forma ovalada (80,3 % y 88,5 % en el lado derecho e izquierdo, respectivamente) Los forámenes infraorbitarios se ubicaron a una distancia media de 5,56 ± 3,95 y 4,91 ± 2,08 mm, por debajo del MOI en los lados derecho e izquierdo; 27,13 ± 2,6 y 26,99 ± 2,73 en el lado derecho e izquierdo desde la línea maxilar mediana, 11,96 ± 3,45 mm y 12,18 ± 3,35 de la PNL en el lado derecho e izquierdo y 29,59 ± 3,59 y 29,65 ± 3,28 por encima de la cresta alveolar en los lados derecho e izquierdo. No hubo diferencias estadísticamente significativas entre los lados izquierdo y derecho o entre sexos. La mayoría de IOF (37,5 % y 55,9 % en el lado derecho e izquierdo, respectivamente) se ubicaron en el plano vertical que pasa por el segundo premolar maxilar.

Chemokine CCL21 in anterior cingulate cortex is involved in chronic neuropathic pain in a rat model / 中国组织工程研究

BACKGROUND: The pathogenesis of chronic pathological pain is yet unknown. Some studies have shown that after spinal cord injury, CCL21 can activate microglia in the central nervous system and is expressed only in damaged neurons, promoting the formation of chronic pathological pain. OBJECTIVE: To investigate whether the anterior cingulate cortex is involved in the formation of chronic pathological pain after inferior orbital nerve ligation in rats, and whether blocking chemokine CCL21 in the anterior cingulate cortex can reduce the chronic neuropathic pain. METHODS: A total of 80 male Sprague-Dawley rats were randomly divided into 4 groups with 20 rats in each group. In the sham group, only the infraorbital nerve of the rats was exposed; in the model group, the left infraorbital nerve was ligated; in the anti-CCL21 group, CCL21 neutralizing antibodies was administered to the anterior cingulate cortex of the rats on the 7th day after surgery; and in the PBS control group, PBS solution was given into the anterior cingulate cortex of rats on the 7th day after surgery. Rats in the sham and model groups were subjected to behavioral tests on the 3rd, 5th, 7th, and 14th days after surgery, and those in the anti-CCL21 and PBS control groups were subjected to the behavioral test at 6 hours after administration. All rats were sacrificed under anesthesia after behavioral tests. The cortical tissues were taken from the anterior cingulate, and the protein content of CCL21 was determined by western blot and immunofluorescence. RESULTS AND CONCLUSION: The pain threshold of the rats in the model group was lower than that in the sham group, and the expression of CCL21 in the anterior cingulate cortex was significantly higher in the model group than the sham group. After the administration of CCL21 neutralizing antibody, the expression of CCL21 was reduced to some extents, and the rat pain threshold was increased accordingly. These findings reveal that the anterior cingulate cortex of rats may be involved in the production of chronic pathological pain, and the administration of CCL21 neutralizing antibody can relief the pain.

Correlation analysis of infraorbital foramen with related anatomical structures / Análisis de correlación del foramen infraorbitario con estructuras anatómicas relacionadas

The anatomical localization of foramen infraorbitale (FOI) and its relationship with ambient structures are of great importance for clinicians and surgeons. This study was performed on seventy five skulls, and the distance between FOI to important anatomical formations, angular position of the zygomatic bone and the relationship between these parameters were investigated on both sides. The distance of FOI to margo infraorbitalis (MI), apertura piriformis (AP) and spina nasalis anterior (SNA), upper face height (UH) and upper face width (UW) were measured. Zygomatic bone triangle angles (SA, PA, IA) and porion-nasion-spina nasalis anterior angle (PNS) were measured from lateral view of the skull. While there was no significant difference between right and left measurement except for PA (p=0.03), the distance from FOI to MI is showed a very high degree positive correlation between the right and left sides, the distance from the FOI to AP was weak correlated only right side.

La localización anatómica del foramen infraorbitario (FIO) y su relación con las estructuras adyacentes son de gran importancia para los médicos y cirujanos. Este estudio se realizó en setenta y cinco cráneos, y se investigó la distancia entre FIO a formaciones anatómicas importantes, la posición angular del hueso cigomático y la relación entre estos parámetros en ambos lados. Se midió la distancia de FIO al margen infraorbitario (MI), apertura piriforme (AP) y espina nasal anterior (ENA), altura superior de la cara (AC) y ancho superior de la cara (AC). Los ángulos del triángulo óseo cigomático y el ángulo anterior porion-nasion-epina nasal se midieron desde la vista lateral del cráneo. Si bien no hubo una diferencia significativa entre la medición derecha e izquierda, a excepción AP (p = 0,03), la distancia de FIP a MI mostró una correlación positiva de alto grado entre los lados derecho e izquierdo, la distancia de FIO a AP fue débil correlacionado solo en el lado derecho.

Clinical application of resorbable plate in orbital fracture surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical application of resorbable implants in orbital fracture repair surgery.<p>METHODS: A retrospective analysis of 48 eyes in 48 cases of orbital fracture, all patients were treated with resorbable implants for orbital fracture repair. During operations we exposed fully fracture defect range and returned the tissues that entered the paranasal sinus. A resorbable implant was trimmed to proper sizes according to the fracture defect range and fixed with 2 absorbable screws. The accuracy of plate positioning of the reconstructed orbit and the practicability of clinical use of resorbable implant were judged by the ophthalmic examination and computed tomography(CT)scan before and after operation. <p>RESULTS: All the patients completed the operation successfully and had no serious complications during or after surgery. All the patients had a good anatomical restoration by the postoperative CT scan. One year re-examination after operation, among 18 eyes with limitation of extraocular muscle movement(EOM)before operation 1 eye(6%)with limitation of EOM improved after surgery,17 eyes(94%)with limitation of EOM got cured. Among 30 cases with diplopia before operation 12 cases(40%)with diplopia improved after surgery, 18 cases(60%)with diplopia got cured. Among 32 eyes with enophthalmos before operation 10 eyes(31%)with enophthalmos improved after surgery, 22 eyes(69%)with enophthalmos get cured. Among 40 eyes with suborbital skin numbness before operation 33 eyes(82%)with suborbital skin numbness improved after surgery, 7 eyes(18%)with suborbital skin numbness got cured. Only one eye got lower eyelid entropion after surgery and was resolved by the second correction of entropion.<p>CONCLUSION: The resorbable implant can repair the fractures of orbital wall well. It is a better material of orbital fracture repairment.

Endoscopic anatomy of infraorbital/maxillary nerves in endoscopic transmaxillary approach / 中国神经精神疾病杂志

Objective To explore the localization and guidance value of infraorbital/maxillary nerve in endoscopic transmaxillary approach, and to provide anatomical data for clinical operation. Methods The eight adult cadaver heads were dissected by means of the endoscopic transmaxillary approach to expose the infraorbital/maxillary nerve, and relevant data were collected. Results In 8 cases, 16 maxillary nerves arose from the trigeminal ganglion of the trigeminal nerve and emerged from the foramen rotundum, transited to the infraorbital nerve at the infraorbital fissure, then traveled in the infraorbital canal and out of the infraorbital foramen. The infraorbital/maxillary nerve could be divided into four segments according to the foramen rotundum, infraorbital groove and infraorbital foramen: the terminal segment, the infraorbital nerve and its terminal branches to the face, distal to the infraorbital foramen; the orbitomaxillary segment and the orbitomaxillary segment of the infraorbital nerve within the infraorbital canal from the infraorbital foramen along the infraorbital groove (length 11.7 ±2.5 mm ), which was readily identified in the roof of the maxillary sinus in all specimens. The pterygopalatine segment, the pterygopalatine segment within the pterygopalatine fossa, which started at the infraorbital groove to the foramen rotundum (length 13.4±2.1 mm); The intracranial segment, the intracranial segment from the foramen rotundum to the trigeminal ganglion(length 15.2±3.9 mm). Conclusion The infraorbital nerve can serve as a anatomical landmark for endoscopic transmaxillary approach to get access to infratemporal fossa, pterygopalatine fossa, trigeminal ganglion and lateral wall of the cavernous sinus.

Eficacia de la técnica infraorbitaria en incisivos y premolares maxilares usando lidocaína al 2% con epinefrina 1:80,000 / Anesthetic efficacy of the infraorbital nerve block in maxillary incisors and premolars using 2% lidocaine with epinephrine 1:80,000

Objetivos: Los autores condujeron un ensayo clínico no controlado para determinar la efectividad de la técnica infraorbitaria, para proporcionar anestesia pulpar profunda en incisivos y premolares maxilares. Material y métodos: Diecinueve adultos voluntarios recibieron 1.8 mililitros de lidocaína al 2% con epinefrina 1:80,000 con una técnica infraorbitaria intraoral. Los investigadores usaron un electric pulp tester (vitalómetro) para medir la anestesia pulpar en incisivos y premolares maxilares. Los participantes informaron sobre anestesia en tejidos blandos, y molestias durante la inyección además de que valoraron el tiempo de inicio de la anestesia y la duración de la misma. Los autores analizaron los datos usando el programa estadístico STATA 9®. Resultados: La mayoría de los sujetos tenía 21 años (30%), el sexo más común fue el sexo femenino (n = 12-60%). Los autores evaluaron con escala visual análoga (VAS), la percepción del dolor al momento de aplicar la anestesia, encontrando que el 57.9% de los pacientes (n = 11) lo catalogaron como moderado (escala de 3-6). Al evaluar el éxito anestésico, observaron un mayor número de episodios en el canino y el primer premolar (57.9%, n = 9 - IC 95%), Los autores observaron un importante número de fallas en la anestesia pulpar de incisivos centrales y laterales (100-84.2%, respectivamente). El inicio de la anestesia fue a los 12-19 minutos, siendo el canino el de mayor número de reportes con un 47.4%. La incidencia de sensación subjetiva de anestesia de los tejidos blandos en piel de párpado, ala de la nariz y piel de labio superior fue del 100%, los autores observaron que el 100% de los sujetos la calificaron como desagradable (VAS). Conclusiones: La técnica infraorbitaria produce anestesia exitosa en sólo el 57.9% de los caninos y primeros premolares maxilares; es ineficaz para anestesiar incisivos centrales y laterales, luego de ser evaluada con un riguroso test de vitalometría, se produce anestesia de tejidos blandos que es catalogada como incomoda. Los autores consideran que la utilidad de la técnica infraorbitaria en odontología es cuestionable y se deben considerar otras técnicas para los incisivos y premolares maxilares.

Objectives: The authors conducted a clinical-trial, uncontrolled study to determine infraorbital nerve block effectiveness. Material and methods: Nineteen adult volunteers received 1.8 mL of lidocaine 2% with epinephrine 1:80,000 with an intraoral, infraorbital nerve block. Researchers used an electric pulp tester to measure pulp anesthesia in maxillary incisors and premolars. Participants reported soft tissue anesthesia and discomfort during the injection procedure; anesthesia onset time and its duration were also assessed and analyzed. Authors analyzed data using STATA statistical program 9®. Results: Most of the subjects in our trial were 21 years old (30%); the number of female participants (n = 12 - 60%) was greater than that of male participants. Authors evaluated pain perception when injecting anesthesia with a visual analogue scale (VAS), finding that 57.9% of patients (n = 11) categorized the pain as moderate (in a scale of 3-6). When assessing anesthesia success, it was observed that a greater number of canine teeth and first premolars (57.9%, n = 9 - CI 95%) were anesthetized. The authors also observed a significant greater number of nonresponse (non-anesthetized) cases in central and lateral incisors (100-84.2%, respectively). Anesthesia onset was at 12 to 19 minutes, with canines exhibiting the largest number of anesthetized reports with 47.4%. There was a 100% incidence of subjective feeling of soft tissue anesthesia in lower eyelid skin, skin of the nose and skin of the upper lip. Authors noted that 100% of the subjects rated it as unpleasant (VAS). Conclusions: Infraorbital anesthesia technique achieved successful anesthesia in only 57.9% of upper canines and first premolars; it proved ineffective for anesthetizing central and lateral incisors. This was demonstrated after these teeth were evaluated using rigorous pulp vitality testing. Soft tissue anesthesia occurred and it was classified as uncomfortable. Authors consider that usefulness of infraorbital nerve block technique in dentistry was questionable.

Infraorbital Nerve Hypesthesia after Inferior Orbital Wall Fracture and Reconstruction Surgery

PURPOSE: To report the incidence of infraorbital nerve hypesthesia after inferior orbital wall fracture and reconstruction surgery and analyze the duration and factors to influence the occurence of the infraorbital nerve hypesthesia. METHODS: From March, 2001 to March, 2016, the medical records of 171 patients with isolated orbital floor fracture reconstructed with porous polyethylene or titanium mesh was analyzed retrospectively. Injury mechanism, fracture type, time interval to surgery, fracture size, type and thickness of implant were analyzed. Orbit computed tomography scan was performed at preoperative and postoperative 6 weeks. RESULTS: Mean age was 30.4 years (male:female = 130:41). The mean time interval to surgery was 9.5 days. Incidence of infraorbital hypesthesia was 9.9% preoperatively, 38% in a week of surgery, 13.5% in 6 weeks and 5.8% in 6 months. Infraorbital hypesthesia lasts 20.5 weeks and the length of infraorbital canal was the only risk factor of persistent infraorbital hypesthesia. CONCLUSIONS: Postoperative infraorbital nerve hypesthesia presents in a week in most patients. It last about 20.5 weeks, then mostly recovers in 6 months. This study will be useful to predict the clinical course of the patients with infraorbital nerve hypesthesia. Therefore, full explanation about the facial sense change is necessary for the patients with inferior orbital wall fracture.

Zygomaticomaxillary complex fractures with infraorbital nerve damage / 华西口腔医学杂志

Zygomaticomaxillary complex (ZMC) fracture is a common type of maxillofacial fracture. In addition to facial depression and diplopia, paresthesia of the lower eyelid, malar regions, nose skin, upper lip skin, and mucous membranes occurs because of infraorbital nerve injury. This article reviewed the anatomy, diagnosis, assessment, treatment, and prognosis of ZMC fracture-related infraorbital nerve injury.

Peripheral Neurectomy of Infraorbital Nerve -A Treatment Option for Trigeminal Neuralgia: A Case Report.

Trigeminal neuralgia or tic douloureux is a commonly diagnosed facial pain syndrome with a female predominance and with peak occurrence in the age group of above 50 years. Treatment options range from conservative pharmacologic therapy to invasive surgical procedures. The mode of treatment is based on patient’s systemic health, compliance and severity of the disease. Peripheral neurectomy is the safest and simplest method that can be accomplished under local anesthesia with minimum risks and excellent pain relief to the patient. However, there are incidences where this mode of treatment also fails to manage the disease, and further surgical options must be considered. In this case report, we present a case of a 50-year-old female patient who has undergone peripheral neurectomy of infraorbital nerve.

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

OBJECTIVES: Transpositioning 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 METHODS: In 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. RESULTS: There was no evidence of sensory disturbance during their three month follow-up in any of the patient. CONCLUSION: Infraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve.

Descriptive and Topographic Anatomy of Infraorbital Foramen and Its Clinical Implication in Nerve Block.

Introduction: The aim of this study is to document the morphological and topographical anatomy of the infraorbital foramen (IOF) in relation to the infraorbital rim (IOR) and piriform opening of the nose which is necessary in clinical situations that requires regional nerve blocks. Methods: A total of 100 Indian dry adult human skulls of unknown age and gender were studied. In each skull the IOF’s location was measured with IOR and piriform opening of the nose as reference points. The transverse and vertical diameters of the foramen were also measured. The orientation of accompanying groove and any accessory foramen was noted. Results: Majority of infra-orbital foramina were directed inferomedially on both the right (53.53 percent) and left (53.12 percent) sides. The overall combined distance between the IOR and IOF was 2 to 12 (6.7 ± 1.67) mm, the combined distance between piriformaperture and IOF was 11 to 23 (17.4 ± 2.43)mm. The overall combined vertical diameter was 2 to 7 (4.3 ± 0.95) mm. The overall combined transverse diameter was 1 to 5 (3.6 ± 0.84) mm. Eleven (5.64 percent) accessory infraorbital foramina were found. Conclusion: Knowledge of the anatomical characteristics of IOF locations, diameters, directions and its accessory foramina may have important implications in blocking the infraorbital nerve for surgical and local anaesthetic planning.

Infraorbital nerve schwannoma: A rare cause of upper jaw swelling.

Introduction: Schwannoma of the infraorbital nerve is a rare entity, with lesser than a dozen cases reported in literature and only one from India. Report: This article reports a 23-year-old male presenting with a painless swelling in the cheek, which was eventually diagnosed as infraorbital nerve schwannoma. He underwent a complete excision of the tumor via a Caldwell Luc approach and continues to be disease free on 3 year follow-up. Conclusion: Despite its rarity, infraorbital nerve schwannomas should be considered in the differential diagnosis, of upper jaw swelling. We recommend the Caldwell Luc approach as safe, effective and cosmetically acceptable, for anteriorly based infraorbital schwannomas, and review literature on this unusual entity

A genderwise study on the morphometry of infraorbital foramen and its laterally in dry adult skulls of South Indian population.

Background: The infraorbital foramen is situated in the maxilla and it conveys infraorbital nerve and vessel, the knowledge of its morphometry and variations is therefore mandatory to do therapeutic infraorbital nerve block or any clinical procedures. Aims & Objective: To study the gender wise morphometry of infraorbital foramen and its laterality in dry adult skulls of south Indian population. Materials and Methods: In the present study we examined 100 infraorbital foramina and measured its distance with bony features adjacent to it and the shape, presence of accessory foramina were analysed in relation to gender. The infraorbital foramen was the landmark from which the distance between the following bony structures were examined; Nasion (NAS), Zygomatico-maxillary suture (ZMS), Anterior nasal spine (ANS), and the distance between the inferior orbital rim(IOR) to optic canal (OC), infraorbital foramen IOF), inferior and superior orbital fissure (IF & SF). The average mean and standard deviation were calculated for every measurement. Paired t – test was used to compare the parameters between sides and gender for each measurement. Results: The most common shape of infraorbital foramen found in the present study is oval (39%) followed by semilunar (27%). Round shaped foramen was found in 22% of skulls, triangle shaped foramen was found in 12% and accessory foramina were present in 11% of the skulls. In the present study, we found triangle shaped foramen in 12% skulls and also the number of accessory foramina was found to be higher which emphasise the need to take ethnicity into account as triangle shaped foramen is unique in south Indian population as affirmed by previous authors. Conclusion: The results show significance with respect to gender and side which makes the knowledge of its morphometry obligatory for clinical procedures.

Ultrasound-Guided Infraorbital Nerve Pulsed Radiofrequency Treatment for Intractable Postherpetic Neuralgia: A Case Report

A 60-year-old man presented with pain on the left cheek and lateral nose. The patient had been diagnosed with facial herpes zoster in the left V2 area 6 months previously. Medical treatment was prescribed for 6 months but it had little effect. We blocked the left infraorbital nerve under ultrasound guidance, but pain relief was short term. Therefore, we performed pulsed radiofrequency treatment on the left infraorbital nerve under ultrasound guidance. Six months after the procedure, the reduction of pain was still maintained, and there was no need for further management.

Sensory Impairment in Infraorbital Nerve Following Mid-Facial Fractures

PURPOSE: Sensory impairment in infraorbital nerve is common symptom following mid-facial fractures. The purpose of this study is to document the incidence of sensory impairment in infraorbital nerve following mid-facial fractures and its recovery. METHODS: Three hundreds fourteen patients with mid-facial fracture were included involving emergence areas of infraorbital nerve. Fractures were classified into zygoma fracture, maxilla fracture, complex comminuted fracture and pure blow out fracture. Neurosensory function was assessed with clinical symptoms and light touch test in infraorbital nerve regions. Patients were followed and sensory function was evaluated immediately, 1, 3 and 6 months after trauma. RESULTS: The total series consisted of 198 zygoma fractures, 19 maxilla fractures, 30 complex comminuted fractures and 67 pure blow out fractures. The incidence of sensory impairment was 60% (63% in zygoma fractures, 84% in maxilla fractures, 93% in complex comminuted fractures, 31% in pure blow out fractures). Persistent sensory impairments were remained in 32% (33% in zygoma fractures, 47% in maxilla fractures, 73% in complex comminuted fractures, 6% in pure blow out fractures) 6 months after trauma. Younger patients had better prognosis than older patients in recovery of infraorbital nerve function(p<0.05, chi2-test). Mean recovery time was 11 weeks. CONCLUSION: The incidence of post-traumatic sensory impairment was different according to fracture types. Age of patients and fracture type were important factors that influence to recovery of sensory impairment. Complex comminuted fracture had poor prognosis, and pure blow out fractures had better prognosis than other fractures.

Schwannoma in the maxillary sinus and buccal space: Case report

Schwannomas are tumors which originate from the neuroectodermal Schwann cell of cranial, intraspinal, peripheral and autonomic nerve sheaths, and they are solitary, benign, slow growing and well encapsulated neoplasm. Schwannomas are usually asymptomatic. No strong gender or age predominance exists. The incidence of extracranial schwannomas in the head and the neck region varies from 25~45%. In addition, schwannomas are rare in the maxillary sinus or buccal space. In this paper, it diagnosed and treated a 54-years old female patient, who had schwannoma in the maxillary sinus derived from infraorbital nerves, the branch of the left trigeminal nerve, and a 19-years old male patient, who had schwannoma arose in the buccal space derived from the buccal branch of the right facial nerve. There was no particular complication except sensory extinction of the nerve in the female patient and paralysis by the nerve in the male patient. It is determined those two cases of schwannoma in the rare portion is valuable and herein, it reports those with literature discussions.

Retrobulbar Hematoma after Infraorbital Nerve Block in Trigeminal Neuralgia: A case report

Retrobulbar hematoma can arise from orbital trauma and periorbital or intraorbital procedures, and it can result in several morbidities including vision loss. Making the immediate diagnosis and performing decompression of the retrobulbar hematoma are crucial for preventing serious morbidities such as permanent vision loss. We present here a case of temporary vision loss that was due to iatrogenic retrobulbar hematoma in a patient who received infraorbital nerve block for the treatment of trigeminal neuralgia. A 70-year-old woman with trigeminal neuralgia was treated with infraorbital nerve block. Just after the procedure she experienced acute periorbital swelling, proptosis and worsening visual acuity. Immediate orbital computed tomography was done, and this revealed a retrobulbar hematoma. The patient underwent lateral canthotomy with cantholysis and administration of dexamethasone and mannitol. Improvement of visual acuity began 3 hours after these procedures. Her visual acuity was greatly improved 12 days after admission.

Infraorbital Nerve Function Following Tailoring of Medpor(R) in Reconstruction of Inferior Orbital Wall Fracture

PURPOSE: In the orbital floor fracture, sensory impairment due to the damage of the infraorbital nerve is one of the most common symptom and complication. In this report, we have the assumption that tailoring of medpor(R) for decompression may have correlations to the damage and regeneration of the nerve. METHODS: Among patients who had open reduction for pure orbital floor fracture in our hospital from March 2005 to March 2008, we selected 80 cases. In 40 cases, we inserted tailored medpor(R), and in other 40 cases, non-tailored medpor(R) was inserted. Patient's reports were obtained and analyzed, and the pin-prick test and the 2-point discrimination test on the infraorbital nerve regions were done for testing the sensory impairments. RESULTS: The results show that the patients who adopted sculpture of medpor(R) showed higher tendency of recovery of sensory impairments in the patient's subjective report, static touch sensation, static two point discrimination using. And in postoperative 3 months, there are statistically significant recovery of sensory symptoms, signs and the result of sensory tests. CONCLUSION: From these results, tailored medpor(R) in reconstruction of orbital wall fracture may improve recovery of sensory impairments for decreasing of compression of infraorbital nerve.