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Armando A. Gonzalez Gomar, Alejandro Navas, Angel Nava, Gerardo Graue; Infraorbital Nerve Transposition: Description Of A Novel Corneal Neurotization Technique In A Cadaveric Model. Invest. Ophthalmol. Vis. Sci. 2011;52(14):722.
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© ARVO (1962-2015); The Authors (2016-present)
To develop a new corneal neurotization technique that can be reproducible in human cadavers utilizing the infraorbital nerve.
Interventional study in four adult cadaver orbits. An anteroinferior orbitotomy via an inferior fornix transconjunctival approach coupled with an extended lateral canthotomy was planned for each orbit. The orbital rim and infraorbital foramen were exposed; further, blunt disection continued along the infraorbital nerve emergence in a caudal direction until its terminal branches were visualized. A retrograde osteotomy of the infraorbital foramen and groove was performed. The underlying neurovascular bundle was identified and selective dissection under direct visualization of the infraorbital nerve branches was performed. Tunnelization of the Tenon’s capsule and orbital fat ventral to the inferior rectus muscle and of the periorbit was performed to retrieve and reorient (transpose) the dissected nerve in a cranial direction. Finally, the nerve was sutured to the temporal and nasal limbus. Photographs were taken to document the procedure. The minimal nerve length required to reach the limbus was recorded. All dissections were performed by the same surgeon.
According to the technique proposed, transposition of the palpebral branch of the infraorbital nerve to the sclerocorneal limbus was achieved in 3 out of 4 cases. The minimal average length required by the dissected nerve to reach the limbus without restriction was 22 mm.
The surgical technique proposed is reproducible. The length and width of the infraorbital nerve branches makes them good candidates to use in corneal neurotization research procedures. A live model is necessary to evaluate the degree of corneal reinnervation that this procedure could potentially induce to the anesthetic cornea.
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