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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3181707063
Reconstructive: Head and Neck: Original Articles

Posttraumatic Headache: Surgical Management of Supraorbital Neuralgia

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

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Abstract

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.

©2008American Society of Plastic Surgeons

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