Infraorbital Nerve Decompression for Infraorbital Neuralgia/Causalgia following Blowout Orbital Fractures: A Case Series

Abstract

The purpose of this study was to present the management of a series of patients referred with infraorbital nerve paraesthesia that developed after insignificant orbital floor fracture without diplopia or exophthalmos, and that did not require initial surgical repair. This is a retrospective interventional case series. The main outcome and measures were assessment of preoperative symptoms including neuralgia and sensory symptoms; review of periorbital computed tomography (CT) scans; and assessment of postoperative effects of surgery for infraorbital nerve decompression. Nine patients were identified who developed neuralgia affecting the infraorbital nerve distribution from a cohort of 79 patients who presented with orbital floor fracture. Six were female and three were male. Age range was 22 to 73 years with a mean of 48 years. Six patients were clinically depressed due to the chronic pain. In addition, two patients had dizziness on upgaze; one patient had blurring of central vision on eye movements; and one patient had mood swings. Reviews of CT scans revealed subtle disruption of the infraorbital canal in all cases. All nine patients underwent infraorbital nerve decompression. Abnormal adhesions between the nerve and its bony canal were found in five of nine cases. Follow-up ranged from 3 to 37 months (mean: 18 months). Following surgery, after a variable period of time ranging from 1 day to 3 months, all patients had resolution of their symptoms. Mean follow-up was 18 months. Reconstructive surgeons should be aware that infraorbital nerve neuralgia, secondary to disruption of the nerve in the distorted bony canal, may be another indication for surgical intervention following orbital floor trauma in selected cases, in addition to more traditionally accepted indications. Neuralgia and causalgia are probably more common than previously thought and symptoms should be actively sought in the patient's history or else risk being overlooked and inappropriately managed. Long-term follow-up of such patients is unlikely to be practical. Patient and/or family practitioner education of possible sequelae may be one possible solution to detect this type of problem early. Nerve decompression, where indicated, may improve the patient's neuralgia and associated behavioral changes and quality of life. An optimal diagnostic and management algorithm is yet to be established.

Evaluation of Customized Polyether Ether Ketone Implant in Reconstruction of Orbital Floor Fractures (Clinical Trial)”

“…The infraorbital nerve is in a vulnerable position to injury or entrapment within a collapsed infraorbital canal during orbito-zygomatic fracture. Beigi et al (2017) states that infraorbital nerve neuralgia is an overlooked symptoms in patients with traumatic disruption of the orbital skeleton. Risk of bony canal and nerve adhesion from neglected surgery comes with associated longterm behavioral changes and quality of life affection (35).…”

“…Beigi et al (2017) states that infraorbital nerve neuralgia is an overlooked symptoms in patients with traumatic disruption of the orbital skeleton. Risk of bony canal and nerve adhesion from neglected surgery comes with associated longterm behavioral changes and quality of life affection (35). Proper release of the entrapped orbital content and nerve decompression is an imperative procedure during orbital reconstruction.…”

Infraorbital Neuralgia Secundary to a Retention Mucous Cyst in Maxillary Sinus: A Case Report

“…The trigeminal neuralgia can be divided in primary or idiopathic, when no cause is identified and in secondary when a cause is identified in the central nervous system: tumor, infartion, multiple sclerosis or trauma [4]. According to the symptomatic aspect, the trigeminal neuralgia can be divided in "typical", when the pain is paxorismal and "atypical", when the paroxismal pains is associated with constant pain, as the patient descrbied in the case [5].…”

Craniofacial neuralgias

“…In one case series, 20 nine patients with orbital floor fractures that did not entrap extraocular muscles, cause enopthalmos, diplopia or loss of ocular movements and thereby did not meet criteria for surgical repair, yet entrapped the infraorbital nerve, resulting in significant infraorbital neuralgia. These patients suffered from chronic pain and depression, which resolved after decompression of the infraorbital canal.…”