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Posttraumatic Headache: Surgical Management of Supraorbital Neuralgia

Ducic, Ivica M.D., Ph.D.; Larson, Ethan E. M.D.

Plastic and Reconstructive Surgery: June 2008 - Volume 121 - Issue 6 - p 1943-1948
doi: 10.1097/PRS.0b013e3181707063
Reconstructive: Head and Neck: Original Articles

Background: Supraorbital neuralgia is a distinct clinical entity that presents with episodic, often unilateral, long-lasting attacks of moderate to severe frontal pain. This may ensue following a traumatic or surgical insult to the supraorbital or supratrochlear nerve. Surgical management of these patients is only sporadically discussed in the available literature.

Methods: The authors report a series of six consecutive patients undergoing surgical excision of the supraorbital and supratrochlear nerves on the affected side for refractory posttraumatic or postoperative supraorbital neuralgia. End-to-end nerve coaptation by means of a neural tube conduit was used to prevent future neuroma formation. Success was defined as a 50 percent or greater reduction of preoperative pain level.

Results: Five of six patients demonstrated at least a 50 percent reduction in pain. Three patients experienced complete pain cessation postoperatively. There was one treatment failure. Pain was measured using a visual analogue pain scale. Preoperative average pain was 9.16 ± 1.3 and postoperative average pain was 1.5 ± 1.9, an improvement of 7.7 points or 84 percent (p = 0.03). Mean age of the patients was 42 years. Mean follow-up was 14 months. No surgical complications occurred.

Conclusion: Excision of the supraorbital and supratrochlear nerves with end-to-end coaptation of the proximal nerve stumps by means of a neural tube appears to be an effective treatment in selected patients with chronic, posttraumatic supraorbital neuralgia.

Washington, D.C.

From the Department of Plastic Surgery, Georgetown University Hospital.

Received for publication May 2, 2007; accepted September 11, 2007.

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Ivica Ducic, M.D., Ph.D., Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road, N.W., Washington, D.C. 20007,

©2008American Society of Plastic Surgeons