PubMed · 7337998
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T J Baker. 1981. Upper blepharoplasty.. https://pubmed.ncbi.nlm.nih.gov/7337998/
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Injury to the eyelids, lacrimal tract and orbital walls need a surgical management when any lesion of the globe has been already eliminated or repaired. Surgery can be delayed safely for 24 to 48 hours in palpebral or lacrimal injuries. Except for the trapp-door fractures in children who need an immediate repair, patients with orbital fractures are brought to surgery within the first or second week. If the eye remain intact after the initial repair, any additional reconstruction is usually carried out several months later to be sure to get a good result.
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A detailed description of the anatomical relationships of the supraorbital nerve as it courses across the forehead and under the scalp cannot be found in most anatomy textbooks, and illustrations of the nerve beyond the superior orbital rim frequently misrepresent its course. Because the supraorbital nerve is a structure at risk in many plastic surgical techniques, the plastic surgeon would benefit from a clearer understanding of its anatomy and function. The supraorbital nerve was studied anatomically in 12 (24 half-head) fresh cadaver specimens, and its sensory distribution was studied in 30 living subjects using selective nerve blocks. Beyond the orbital rim, the supraorbital nerve has two consistently present divisions: (1) a superficial (medial) division that passes over the frontalis muscle, providing sensory supply to the forehead skin and only to the anterior margin of the scalp in 90 percent of the study subjects; and (2) a deep (lateral) division that runs cephalad across the lateral forehead between the galea aponeurotica and the pericranium as the sensory nerve to the frontoparietal scalp. When a forehead lift is performed, injury to this deep division causes most of the distressful sequelae of scalp numbness and paresthesia. Unlike the superficial division, the course of the deep division in all cadaver specimens and its sensory distribution in all living volunteer subjects was consistent. This study has application for any procedure requiring scalp or forehead incisions, such as the forehead lift and the endoscopic facial techniques.(ABSTRACT TRUNCATED AT 250 WORDS)