Infraorbital Nerve Block for Isolated Orbital Floor Fractures Repair

Abstract

Background:Orbital blowout fractures can be managed by several surgical specialties including plastic and maxillofacial surgery, otolaryngology, and ophthalmology. Recommendations for surgical fracture repair depend on a combination of clinical and imaging studies to evaluate muscle/nerve entrapment and periorbital tissue herniation.Methods:The aim of this study was to verify the applicability of regional anesthesia when repairing orbital floor fractures. A retrospective chart review was performed for isolated orbital floor fractures treated at the Department of Maxillofacial Surgery in Florence between May 2011 and July 2012. The study included 135 patients who met the inclusion criteria: 96 subjects were male (71%) and 39 were female (29%). The mean age was 45.3 years, ranging from 16 to 77 years.Results:The results revealed that isolated anterior orbital floor fractures can be safely repaired under regional and local anesthesia. Regional and local anesthesia should be combined with intravenous sedation when the fracture involves the posterior floor. The surgical outcome was comparable to the outcome achieved under general anesthesia. There was a lower rate of surgical revisions due to concealed malposition or entrapment of the inferior rectus muscle (19% vs 22%). However, this result was not statistically significant (P > 0.05).Conclusions:There are several advantages to surgically repairing isolated orbital floor fractures under regional and local anesthesia that include the following: surgeons can check the surgical outcome (enophthalmos and extrinsic ocular muscles function) intraoperatively, thereby reducing the reoperation rate; patient discomfort due to general anesthesia is eliminated; and the hospital stay is reduced, thus decreasing overall healthcare costs.

Localization of infraorbital foramen and accessory infraorbital foramen with reference to facial bony landmarks: predictive method and its accuracy

“…This nerve provides mid-facial sensation around lower eyelids, lateral side of nose, nasal septum, and upper lips [ 2 , 3 ]. The ION block is used for regional anesthesia in many procedures including maxillofacial, eye, nose, and dental surgeries [ 4 - 7 ]. Moreover, it is beneficial in treating intractable infraorbital neuralgia [ 8 , 9 ] and reducing postoperative pain [ 5 , 10 , 11 ].…”

Pediatric regional anesthesia: A review of the relevance of surface anatomy and landmarks used for peripheral nerve blockades in infants and children

“…In 1994, an adult study (Lynch et al, ) described two approaches of the infraorbital nerve blockade, intraoral, and extraoral (percutaneous), where both the techniques involve identifying the landmarks for the infraorbital foramen. Most recent studies (Spinelli et al, , Aggarwal et al, ) have also investigated the position of the infraorbital foramen relative to other external anatomic landmarks, providing similar distance measures (Table ). The landmarks used for infraorbital nerve blockade were also investigated in neonate cadavers ( n = 15) (Bosenberg and Kimble, ).…”

Infraorbital foramen location in the pediatric population: A guide for infraorbital nerve block

“…IONB are usually applied in management of postoperative pain associated with cleft lip surgery . Otherwise, IONB has been used in instances of endoscopic sinus surgery, nasal fracture, orbital floor fracture, and transsphenoidal hypophysectomy . Potential pitfalls in IONB procedures include maxillary sinus puncture and globe penetration .…”