Cranial Maxillofac Trauma Reconstruction 2017; 10(01): 22-28
DOI: 10.1055/s-0036-1592095
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Bijan Beigi
1  Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
,
Mazda Beigi
2  Department of Life Sciences, Brunel University, Uxbridge, United Kingdom
,
Nuwan Niyadurupola
1  Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
,
Manuel Saldana
4  Eastbourne District General Hospital, Eastbourne, United Kingdom
,
Nabil El-Hindy
3  York Teaching Hospital NHS Foundation Trust, York, United Kingdom
,
Deepak Gupta
1  Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
› Author Affiliations
Further Information

Publication History

30 March 2016

29 April 2016

Publication Date:
17 October 2016 (eFirst)

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.