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.

Clinical Outcomes of Individualized Botulinum Neurotoxin Type A Injection Techniques in Patients with Essential Blepharospasm

PURPOSE: To assess the clinical outcomes following botulinum neurotoxin type A (BoNT-A) treatment with an individualized injection technique based on the types of spasms and to compare the results of the individualized injection technique with those of the conventional injection technique in the same patients. METHODS: From November 2011 to July 2013, 77 BoNT-A injections were performed in 38 patients. Eighteen patients were treated with conventional BoNT-A injections before 2011, and 20 patients were referred to our hospital for unsatisfactory results after a conventional injection technique. We classified the patients by spasm-dominant sites: the lateral orbital area, representing the orbital orbicularis-dominant group (ODG); the glabella, representing the corrugator-dominant group (CDG); and the ptosis, representing the palpebral part of the orbicularis-dominant group (PDG). We increased the injection dose into the spasm-dominant sites of the blepharospasm groups. We assessed subjective symptom scores (functional disability score, FDS) after treatment. RESULTS: This study included 38 patients (26 women, 12 men; mean age, 60.6 +/- 10.9 years). There were 21 patients in the ODG, 10 patients in the CDG, and 7 patients in the PDG. Mean ages were 59.7 +/- 12.6, 59.8 +/- 8.5, and 66.8 +/- 9.0 years, and mean BoNT-A injection dose was 38.8 +/- 11.2, 38.8 +/- 11.2, and 38.8 +/- 10.8 U in each group, respectively (p = 0.44, 0.82 Kruskal-Wallis test). Mean FDS after injection was 1.7 +/- 0.7 in the ODG, 1.4 +/- 0.8 in the CDG, and 1.2 +/- 0.3 in the PDG. There were significant differences in reading and job scale among the three groups. In a comparison between the conventional and individualized injection techniques, there was a significant improvement in mean FDS and in the reading scale in the PDG with the individualized injection technique. The success rate was 92.1% in the conventional injection group and 94.1% in the individualized injection group. CONCLUSIONS: The individualized injection technique of BoNT-A according to the spasm-dominant site is an effective and safe treatment method for essential blepharospasm patients.