J Korean Assoc Oral Maxillofac Surg.  2015 Apr;41(2):74-77. 10.5125/jkaoms.2015.41.2.74.

Infraorbital nerve transpositioning into orbital floor: a modified technique to minimize nerve injury following zygomaticomaxillary complex fractures

• Kotrashetti SM
• Kale TP
• Bhandage S
• Kumar A

• KMID: 2189466
• DOI: http://doi.org/10.5125/jkaoms.2015.41.2.74

Abstract

OBJECTIVES
Transpositioning of the inferior alveolar nerve to prevent injury in lower jaw has been advocated for orthognathic, pre-prosthetic and for implant placement procedures. However, the concept of infra-orbital nerve repositioning in cases of mid-face fractures remains unexplored. The infraorbital nerve may be involved in trauma to the zygomatic complex which often results in sensory disturbance of the area innervated by it. Ten patients with infraorbital nerve entrapment were treated in similar way at our maxillofacial surgery centre.
MATERIALS AND METHODS
In this article we are reporting three cases of zygomatico-maxillary complex fracture in which intra-operative repositioning of infra-orbital nerve into the orbital floor was done. This was done to release the nerve from fractured segments and to reduce the postoperative neural complications, to gain better access to fracture site and ease in plate fixation. This procedure also decompresses the nerve which releases it off the soft tissue entrapment caused due to trauma and the organized clot at the fractured site.
RESULTS
There was no evidence of sensory disturbance during their three month follow-up in any of the patient.
CONCLUSION
Infraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve.

Keyword

Infraorbital nerve transposition; Paresthesia; Zygomaticomaxillary complex fractures

MeSH Terms

Follow-Up Studies
Humans
Jaw
Mandibular Nerve
Nerve Compression Syndromes
Orbit*
Paresthesia
Surgery, Oral

Figure

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  Fig. 1 Para-nasal sinus view.

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  Fig. 2 Fracture line running through infraorbital canal.

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  Fig. 3 Dissection of the nerve to free it from fracture line.

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  Fig. 4 Line diagram showing fracture line running through the infraorbital foramen.

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  Fig. 5 Nerve repositioned into orbital floor.

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  Fig. 6 Line diagram showing nerve transposed using nerve hook.

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  Fig. 7 Plating after transposition of nerve.

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