Dorothee Wiewrodt1, Wolfgang Wagner. 1. Department of Neurosurgery, Section of Pediatric Neurosurgery, The University Hospital of Mainz, Mainz, Germany.
Abstract
INTRODUCTION: In a series of 26 infants undergoing frontoorbital advancement in their first year of life, the supraorbital and supratrochlear nerves were not preserved during surgery in nearly all cases. Of these 26 patients, 25 could be followed up postoperatively. RESULTS: None of the children spontaneously complained of any sensory disturbances thereafter. In neurologic follow-up examinations or telephone interviews 11-81 (median, 39) months after surgery, the patients, respectively their parents were explicitly asked for sensory deficits. The majority of patients had no sensory disturbances at all; two patients reported on dysesthesias when touching the forehead, not affecting them in their daily life. CONCLUSIONS: It is concluded that (1) anatomical transsection of the supraorbital or supratrochlear nerve in very young patients may be functionally fully compensated over time, (2) the preservation of the supraorbital or supratrochlear nerve in frontoorbital advancement in patients less than 1 year of age is of no major significance in the long term and (3) partial anatomical preservation with functional impairment of the nerves may result in dysesthesias in the forehead. Therefore, from a practical surgical standpoint, deliberate anatomical transsection in this age group may be superior to partial morphological preservation of the nerves with subsequent functional impairment.
INTRODUCTION: In a series of 26 infants undergoing frontoorbital advancement in their first year of life, the supraorbital and supratrochlear nerves were not preserved during surgery in nearly all cases. Of these 26 patients, 25 could be followed up postoperatively. RESULTS: None of the children spontaneously complained of any sensory disturbances thereafter. In neurologic follow-up examinations or telephone interviews 11-81 (median, 39) months after surgery, the patients, respectively their parents were explicitly asked for sensory deficits. The majority of patients had no sensory disturbances at all; two patients reported on dysesthesias when touching the forehead, not affecting them in their daily life. CONCLUSIONS: It is concluded that (1) anatomical transsection of the supraorbital or supratrochlear nerve in very young patients may be functionally fully compensated over time, (2) the preservation of the supraorbital or supratrochlear nerve in frontoorbital advancement in patients less than 1 year of age is of no major significance in the long term and (3) partial anatomical preservation with functional impairment of the nerves may result in dysesthesias in the forehead. Therefore, from a practical surgical standpoint, deliberate anatomical transsection in this age group may be superior to partial morphological preservation of the nerves with subsequent functional impairment.