Back to 2012 Annual Meeting Program
Anatomic Study of the Compression Points of the Supraorbital and Supratrochlear Nerves
Santosh S. Kale, MD, MBA; Thomas H. Tung
Washington University School of Medicine, Saint Louis, MO, USA
Hypothesis: Anatomic dissection will reveal discrete and previously unrecognized entrapment points of the supratrochlear and supraorbital nerves.
Background: Chronic headaches can be functionally debilitating and limit a patient’s ability to perform basic activities of daily living. The etiology is often unclear and multifactorial, and as a result, success rates with medical treatment can be temporary and inconsistent. Recent studies have linked headaches to sensory nerve entrapment and have shown promising but inconsistent results with surgical decompression. As in the extremities, the complete release of all potential compression points is necessary for maximal pain relief and a successful outcome. The surgical approach to the supraorbital and supratrochlear nerves includes an upper blepharoplasty incision or an endoscopic brow approach. Entrapment of these nerves at the superior orbital rim is not well recognized and has not been previously described for the supratrochlear nerve.
Methods: Six whole cadaver orbits were dissected using an upper lid blepharoplasty incision. Dissection was carried out through the plane between the obicularis and the orbital septum towards the supraorbital rim. The supratrochlear and supraorbital nerves were identified and neurolysed under 4.5x loupe magnification. Compression charecteristics (bony, tendinous, ligamentous, fascial) were noted as was the relationship to the supraorbital rim and the superior oblique pulley.
Results: A consistent compression point was noted for the supraorbital nerve when traversing a supraorbital notch and for the supratrochlear nerve at the superior orbital rim. However, no bony notch typically exists for the supratrochlear nerve, possibly making it more susceptible to compression by overlying fascial and periosteal bands.
Conclusion: This study identifies discrete and consistent compression points for both the supraorbital and supratrochlear nerves at the superior orbital rim. Although further clinical studies are necessary, the findings demonstrate compression points that are not accessed by the endoscopic approach. Even with an open approach, if not recognized and released, these compression sites may contribute to incomplete pain relief and a suboptimal outcome.
Back to 2012 Annual Meeting Program