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Valerie Chen, Hee Joon Kim, Brent Hayek, Hans E Grossniklaus, Ted H Wojno; The utility and technique for infraorbital and supraorbital nerve biopsies. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3434.
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Enlargement of the infraorbital and supraorbital nerves can most commonly indicate perineural invasion of a malignancy or benign conditions such as idiopathic orbital pseudotumor. The purpose of this study is to review the role of supraorbital and infraorbital nerve biopsies in patients presenting with radiographic enlargement of these nerves and to elucidate the surgical technique involved in obtaining these biopsies.
A 5-year chart review (2009-2014) was performed at The Emory Clinics. Patients with radiographic confirmation of enlarged supraorbital and/or infraorbital nerves that underwent a biopsy were included in the review. Charts were reviewed for the following data: patient demographics and history, clinical symptoms and findings, radiographic findings, surgical method, and treatment.
A total of 6 patients met the inclusion criteria. Five patients (83%) were female and 1 (17%) was male with the average age being 72.3, ranging from 36-90 years. Five of the 6 patients had a history of a cutaneous malignancy. All 6 patients presented with either diplopia and/or dysesthesias on the affected side. Clinical examination confirmed decreased V1 and/or V2 sensation for 5 of the 6 patients. Imaging revealed enlargement of V1, V2, and/or V3 for all of the patients.<br /> Supraorbital nerve biopsies were performed for 2 patients via a sub-brow incision onto the superior orbital rim with reflection of the periosteum that revealed the nerve. One confirmed squamous cell carcinoma and one confirmed mucoepidermoid carcinoma. The remaining 4 patients underwent infraorbital nerve biopsies via a transconjunctival fornix-based orbitotomy with subperiosteal dissection along the orbital floor followed by unroofing of the infraorbital canal. The biopsy confirmed squamous cell carcinoma for the 3 patients with a history of cutaneous squamous cell carcinoma. One patient confirmed idiopathic orbital inflammation. Five of the 6 patients had initiation of treatment in less than a month. One patient was lost to follow-up.
For patients presenting with enlarged supraorbital and/or infraorbital nerves, biopsies of these nerves can rapidly confirm the underlying condition that can facilitate early treatment. A sub-brow approach offers a direct access to the supraorbital nerve while a transconjunctival fornix-based anterior orbitotomy with unroofing of the infraorbital canal allow access to the infraorbital nerve.
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