Location of the infraorbital foramen with reference to soft tissue landmarks

Three-point Method Nerve Block for Relieving Pain of Microbotox Injection in Middle and Upper Face

Background

With the popularity of microbotox, pain caused by multiple microdroplets and subcutaneous injection of botulinum toxin is increasing. This study presents a new, refined, three-point nerve block technique that provides effective pain relief during minimally invasive injection therapy targeting the middle and upper face.

Methods

Fifty volunteers underwent facial ultrasonography to measure the locations of the supraorbital and infraorbital foramen. Following microdrop Botox injection of the middle and upper face, 100 patients underwent a self-controlled study to analyze whether a three-point nerve block surpasses topical anesthesia for reducing injection pain. The visual analog scale pain score, the time of the three-point method and botulinum toxin injection, and side effects were recorded.

Results

Among the volunteers, the location of the supraorbital and infraorbital foramen showed no statistical difference between the left and right sides. For the 100 patients (13 men, 87 women) who underwent the three-point nerve block, the visual analog scale pain scores on the experimental side were significantly lower than those on the control side, except in the frontotemporal region (2.46 ± 0.50, 2.42 ± 0.47, P > 0.05). The duration of the unilateral three-point nerve block was 74.8 ± 5.64 seconds. The total injection time was 189.86 ± 26.79 seconds (range 148-286 s).

Conclusions

The three-point method exerted prominent analgesic effects during middle and upper facial treatments, with benefits including a precise block region, high satisfaction, and simple operation technique. Therefore, clinicians can easily master and apply this method.

A direct transcutaneous approach to infraorbital nerve biopsy

Purpose: To describe a novel transcutaneous infraorbital nerve biopsy technique which can be performed to aid in the diagnosis of perineural invasion (PNI) of facial cutaneous squamous cell carcinoma (SCC).Methods: A single-center retrospective chart review was performed. Patients diagnosed with SCC with PNI via an infraorbital nerve biopsy between February 2019 and February 2020 were included. Data collected consisted of patient demographics, medical history, clinical presentation and exam, histologic and radiographic findings, treatment, and outcomes.Results: Four patients (3 male, 1 female) met inclusion criteria. The mean age at diagnosis was 79.5 years (range 66-85 years). Three of the four patients had a history of facial skin lesions, including actinic keratosis and SCC, involving the nose, cheek, or ear. One patient had no history of cutaneous malignancy. All patients presented with cranial neuropathies, including total V2 hypoesthesia. The most common presenting symptom was facial pain, followed by diplopia, unilateral facial weakness, and hypoesthesia in the V1 and/or V2 distribution. Transcutaneous infraorbital nerve biopsy in all patients revealed squamous cell carcinoma with no biopsy complications.Conclusion: Definitive diagnosis of PNI can be challenging but is important to minimize tumor-related morbidity. Infraorbital nerve biopsy can establish this diagnosis, especially in the context of negative or indeterminate imaging findings. This work comprises the first description of a transcutaneous approach to infraorbital nerve biopsy, which is a minimally invasive technique that can be performed in an outpatient procedure suite with limited to no sedation.

Complications after cosmetic periocular filler: prevention and management

Soft tissue fillers are a mainstay in contemporary, minimally invasive facial rejuvenation procedures owing to timely results and minimal recovery period. Although associated with a low complication rate, soft tissue fillers are not without risk. Complications range from mild superficial skin irregularities to granuloma formation to vascular occlusion leading to skin necrosis or even blindness. Fillers vary in composition, elasticity, hydrophilicity and duration of effect that is tailored to specific cosmetic indications. Selecting the right product for the desired effect can cut down on unwanted outcomes. Severe adverse events can be avoided with safe injection technique, early recognition of symptoms and a thorough knowledge of the local anatomy. This review outlines several complications all providers should recognize and discusses strategies for their prevention and management.

[Surgical anatomy of the maxillary sinus]

BACKGROUND

Improved understanding of the microanatomy of the paranasal sinuses, including its individual variations, makes a substantial contribution to current progress in endonasal endoscopic microsurgery. Microanatomy of the sinuses is an active field of present scientific investitations.

MATERIALS AND METHODS

A comprehensive review on microanatomy of the maxillary sinus is presented from the perspective of contemporary endonasal endoscopic microsurgery.

RESULTS

The range of variation of the individual microanatomy of all sections of the maxillary sinus is presented, in particular to minimize secondary sugical tissue trauma, to avoid complications (e.g. on orbital tissues) and as a basis for the prelacrimal access to the maxillary sinus.

CONCLUSION

Improved understanding of the range of microanatomical variations reduced the burden on the patient while opimizing the effectiveness of the necessary surgical manipulations.

Location of the accessory infraorbital foramen with reference to external landmarks and its clinical implications

The aim of this study was to define the location of the accessory infraorbital foramen (AIOF) with reference to accessible external landmarks in order to facilitate orbital and oculoplastic surgical procedures in the maxillofacial region. Forty-four hemifaces from 25 cadavers were dissected. The lateral canthus, subnasal point, and lacrimal caruncle were used as anatomic reference points. The AIOF was observed in 8 of the 44 hemifaces (18.2%) and was situated at a mean distance of 7.2 mm superomedial to the IOF. The horizontal distance from the lacrimal caruncle to the AIOF was 0.3 mm. In all cases the AIOF was situated at a point that was no more than 8 mm from the intersection point of a vertical line passing through the lacrimal caruncle and an oblique line joining the lateral canthus and the subnasal point. Surgeons anesthetizing or performing surgical procedures in the maxillofacial region should be aware of the frequency of the AIOF (18.2%) and its location (on the superomedial side of the IOF). We propose that injecting at the intersection point of a vertical line passing through the lacrimal caruncle and an oblique line joining the lateral canthus and the subnasal point would successfully block the accessory branch of the infraorbital nerve. Likewise, surgeons operating in this region should be aware of the location of the AIOF in order to avoid inadvertent iatrogenic injury to a duplicated infraorbital nerve.

Location of the infraorbital foramen with reference to soft tissue landmarks for regional nerve blocks during midface surgery

PURPOSE

An infraorbital nerve (ION) block is widely used to accomplish regional anesthesia during surgical procedures involving the midface region. This study aimed to elucidate the exact location of the infraorbital foramen (IOF) in relation to clinically useful soft-tissue landmarks for achieving an effective ION block.

METHODS

Forty-three hemifaces from 23 embalmed Korean cadavers were dissected. The lateral canthus, peak of Cupid's bow, medial limbus, and midline were used as reference points. The distances from the IOF to the midline and the lateral canthus were measured.

RESULTS

The IOF was located approximately 25 mm below the lateral canthus and 27 mm lateral to the midline. In all cases, the IOF was situated within 9.0 mm of the crossing point of the oblique line connecting the lateral canthus to the peak of Cupid's bow and the vertical line through the medial limbus.

CONCLUSION

Considering the spread of an anesthetic agent, injecting it into the crossing point of the oblique line through the lateral canthus to the peak of Cupid's bow and the vertical line through the medial limbus would successfully block the ION in most patients.

The Infraorbital Foramen in a Sample of the Lebanese Population: A Radiographic Study

Purpose

The infraorbital foramen (IOF) is an important structure in the maxillofacial region through which important structures pass. Wide variability in the shape and location of the infraorbital foramen among different populations and ethnic groups is present. So we conducted this study to specify the IOF shape, the presence of accessory foramina, and the IOF location with respect to anatomic landmarks in the Lebanese population.

Patients and method

A cross-sectional retrospective study was conducted on cone-beam computed tomography (CBCT) scans of 105 Lebanese adult patients. Images were reviewed and the shape, diameter, and location of the IOF were recorded. The presence of an accessory foramen was also noted. Then, SPSS version 21 (IBM Corp., Armonk, NY, US) was used for the statistical analysis.

Results

Concerning the distances from the IOF to the anatomic landmarks, the distance from the IOF to the infraorbital margin measured 7.98 ± 1.41 mm, to the lateral nasal wall 10.61 ± 2.39 mm, and to the midline 24.71 ± 2.09 mm. When distances were compared, a statistical difference was only identified in the distance between the IOF and the lateral nasal wall (p=0.00), and the distance between the IOF and the middle of the face (p=0.016) between genders. For the shape of the IOF, 54.8% of the IOF were circular in shape, and this shape was the most common shape in females. An accessory foramen was present in 8.6% of the cases. Finally, the mean diameter of the foramina measured 3.71 ± 0.63 mm.

Conclusion

The IOF shows a lot of variability between different populations. Thus, the exact location should always be remembered during an infraorbital nerve (ION) block, during maxillofacial surgeries, and during esthetic procedures involving the facial region in order to prevent unnecessary complications.

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

Identification of the infraorbital foramen is important in infraorbital nerve block and the prevention of iatrogenic injury of the infraorbital nerve in maxillofacial surgeries. This study assessed the location of 887 infraorbital foramina from 518 adult crania of varied sex and population. The study assessed the midpoint of a line segment spanning from nasospinale to jugale (NS-J) relative to the infraorbital foramen. The mean distance of the NS-J midpoint from the infraorbital foramen was 2.1 ± 1.9 mm (mean ± SD) with a mode of 0 mm (266:887; 30%). The NS-J midpoint was located in the same plane or inferior to the infraorbital foramen in 98.4% of sides (873:887). There were no significant differences between sexes, populations, or sides with regard to the NS-J midpoint to infraorbital foramen distance. The NS-J midpoint can be used to locate the infraorbital foramen in both females and males of varied populations regardless of craniofacial diversity. The results of this study will aid in infraorbital nerve block procedures and maxillofacial surgery.

Morphometric Analysis of the Infraorbital Foramen: The Clinical Relevance

The present study was conducted to ascertain the shape, size, presence of accessory foramina, direction, and the precise position of the infraorbital foramen (IOF) in relation to the inferior orbital margin (IOM), anterior nasal spine (ANS), nasion (Na), maxillary teeth, and supraorbital foramen/notch (SOF/N) in adult skulls in a Sri Lankan population. Fifty-four skulls (42 males and 12 females) were analyzed. The IOF was oval in shape (38.6% and 36.3% on the right and left side, resp.) in a majority of skulls. The direction of the IOF was mostly medially downward (48.6%). Accessory foramina were found in 7.4% of the skulls. The infraorbital foramina were located at a mean distance of 6.52 ± 2.03 mm and 7.30 ± 1.57 mm, vertically below the IOM on the right and left side, respectively; 33.81 ± 2.68 mm and 34.23 ± 2.56 mm from the ANS on the right and left side, respectively; and 42.37 ± 3.52 mm and 42.52 ± 3.28 mm from the Na on the right and left side, respectively. In relation to the upper teeth the majority of IOF (37.5% and 55.9% on the right and left side, resp.) were located in the same vertical axis as the tip of the buccal cusp of the maxillary second premolar tooth.