Chen Valerie H, Hayek Brent R, Grossniklaus Hans E, Wojno Ted H, Kim H Joon
a Department of Ophthalmology , Emory University , Atlanta , Georgia , USA.
Orbit. 2017 Oct;36(5):293-297. doi: 10.1080/01676830.2017.1337177. Epub 2017 Aug 18.
Periorbital nerve enlargement commonly indicates perineural invasion of malignancy or inflammatory conditions. This study reviews the role of supraorbital and infraorbital nerve biopsies in patients presenting with radiographic enlargement and to elucidate the surgical technique involved. A retrospective chart review (1997-2014) was performed at a single tertiary center. Patients with radiographic confirmation of enlarged supraorbital/infraorbital nerves that underwent biopsy were included. Charts were reviewed for: patient demographics and history, clinical symptoms and findings, radiographic findings, surgical method, and treatment. Five patients (4 female, 1 male) met inclusion criteria. Average age was 72.4 years (range 36-90). Four patients had history of cutaneous malignancy. All presented with diplopia and/or dysesthesias. Clinical examination confirmed decreased V1 and/or V2 sensation for 4 patients. Imaging revealed enlargement of V1, V2, and/or V3 in all patients. Infraorbital nerve biopsies were performed in 3 patients via transconjunctival fornix-based orbitotomy with subperiosteal dissection along orbital floor followed by unroofing of infraorbital canal. The remaining 2 underwent supraorbital nerve biopsy via sub-brow incision onto superior orbital rim with reflection of periosteum. Biopsies confirmed squamous cell carcinoma(3), mucoepidermoid carcinoma(1), and idiopathic orbital inflammation(1). Three patients initiated treatment in <1 month. One decided to follow-up closer to home, one was lost to follow-up. For patients presenting with enlarged supraorbital/infraorbital nerves, biopsy can rapidly confirm the underlying condition and facilitate early treatment. A sub-brow approach offers direct access to supraorbital nerve while transconjunctival fornix-based anterior orbitotomy with canal unroofing allows access to infraorbital nerve.
眶周神经增粗通常提示恶性肿瘤的神经周围浸润或炎症性疾病。本研究回顾了眶上神经和眶下神经活检在影像学显示神经增粗患者中的作用，并阐明了相关手术技术。在一家三级医疗中心进行了一项回顾性病历研究（1997 - 2014年）。纳入经影像学证实眶上/眶下神经增粗并接受活检的患者。查阅病历以获取：患者人口统计学和病史、临床症状和体征、影像学检查结果、手术方法及治疗情况。5例患者（4例女性，1例男性）符合纳入标准。平均年龄为72.4岁（范围36 - 90岁）。4例患者有皮肤恶性肿瘤病史。所有患者均出现复视和/或感觉异常。临床检查证实4例患者V1和/或V2感觉减退。影像学检查显示所有患者V1、V2和/或V3增粗。3例患者通过经结膜穹窿入路眶切开术，沿眶底进行骨膜下分离，随后打开眶下管，进行眶下神经活检。其余2例通过眉下切口至眶上缘，翻开骨膜，进行眶上神经活检。活检确诊为鳞状细胞癌（3例）、黏液表皮样癌（1例）和特发性眼眶炎症（1例）。3例患者在1个月内开始治疗。1例决定在离家更近的地方随访，1例失访。对于眶上/眶下神经增粗的患者，活检可迅速明确潜在病因并促进早期治疗。眉下入路可直接暴露眶上神经，而经结膜穹窿入路眶切开术并打开眶下管则可暴露眶下神经。
