Department of Plastic, Reconstructive, Hand and Burn Surgery, Klinikum Bogenhausen, Munich, Germany.
Division of Anatomy, Medical University of Vienna, Vienna, Austria.
Ophthalmic Plast Reconstr Surg. 2023;39(3):293-296. doi: 10.1097/IOP.0000000000002350. Epub 2023 Mar 3.
Sensory alterations of the upper eyelid skin and eyelashes are frequently encountered after upper eyelid surgery. The objective of this study was to provide information on the exact course and distribution of sensory nerve fibers through the anatomic planes in the upper eyelid.
Ten formalin-fixed hemifaces were dissected. The nerve branches of the ophthalmic nerve in the upper eyelid were traced in an anterograde fashion.
A total of 151 nerve fibers were recorded during dissection. The infratrochlear, supratrochlear, supraorbital, and lacrimal nerve contributed each to both the upper eyelid skin innervation and the upper eyelid rim plexus in different distribution patterns. The mean distance from the eyelid margin at which nerve fibers pierced from preseptal into the orbicularis muscle was 14 ± 1.1 mm for nerve fibers targeting the eyelid dermis and 3.7 ± 1.2 mm for nerve fibers targeting the eyelid rim plexus ( p < 0.001). The mean intraorbicular course of nerve fibers was 3 mm (0-17; standard deviation 4.1). The mean distance from the eyelid margin at which nerve fibers pierced from the orbicularis muscle into the preorbicular plane was 10 ± 1 mm for nerve fibers innervating the eyelid dermis and 1.3 ± 0.8 mm for nerve fibers innervating the eyelid rim plexus ( p < 0.001). The mean distance of the preorbicular course of nerve fibers was 2 mm (0-15; standard deviation 3.6).
Based on the findings, a certain degree of postoperative eyelid skin numbness is inevitable while eyelash innervation may be spared in upper blepharoplasty.
上睑手术后，上睑皮肤和睫毛的感觉改变很常见。本研究的目的是提供上睑解剖平面内感觉神经纤维的确切走行和分布信息。
对 10 例福尔马林固定的半面进行解剖。眶上神经的神经分支在上睑以逆行方式追踪。
在解剖过程中记录了总共 151 条神经纤维。滑车下神经、滑车上神经、眶上神经和泪腺神经各自以上不同的分布模式为上睑皮肤和上睑缘丛提供神经支配。神经纤维从眶隔前进入眼轮匝肌的位置距离睑缘的平均距离为 14±1.1mm，用于支配睑皮的神经纤维和 3.7±1.2mm，用于支配睑缘丛的神经纤维（p<0.001）。神经纤维的眶内行程平均为 3mm（0-17；标准差 4.1）。神经纤维从眼轮匝肌进入眶前平面的位置距离睑缘的平均距离为 10±1mm，用于支配睑皮的神经纤维和 1.3±0.8mm，用于支配睑缘丛的神经纤维（p<0.001）。神经纤维眶前行程的平均距离为 2mm（0-15；标准差 3.6）。
根据研究结果，在上睑成形术中，虽然可以避免睫毛的神经支配，但不可避免地会出现一定程度的术后眼睑皮肤麻木。
