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Direct Lateral Canthal Approach to the Zygomaticotemporal Branch of the Trigeminal Nerve for Surgical Treatment of Migraines

Hamawy, Adam M.D.; Li, Xingchen B.A.; Sanniec, Kyle M.D., M.H.A.; Amirlak, Bardia M.D.

Plastic and Reconstructive Surgery: July 2019 - Volume 144 - Issue 1 - p 98e-101e
doi: 10.1097/PRS.0000000000005754
Reconstructive: Head and Neck: Ideas and Innovations
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Summary: Surgical treatment of migraine headaches involves avulsion or decompression of the affected peripheral nerves. One of the sites targeted is site II, the zygomaticotemporal branch of the trigeminal nerve. Although traditionally the procedure involved either an endoscopic or transpalpebral approach to access the nerve, both methods involve general anesthesia in an operating room. The senior authors developed a new technique to directly access the nerve by means of a transverse lateral canthal extension incision that can be performed under local anesthesia in an office setting. A cadaver dissection to assess safety and anatomical variability was performed with visualization and complete avulsion of the zygomaticotemporal branch of the trigeminal nerve in all cases, with no injury to surrounding structures. An office-based procedure for zygomaticotemporal branch of the trigeminal nerve compression can help reduce the risks and costs associated with a general anesthetic and can be used for patients with isolated migraines localized to the zygomaticotemporal branch of the trigeminal nerve or recurrent secondary triggers to that area.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Princeton, N.J.; and Dallas, Texas

From Princeton Plastic Surgeons; and the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication June 29, 2017; accepted November 27, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Bardia Amirlak, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390, bardia.amirlak@utsouthwestern.edu, Facebook: dramirlak, Twitter: @dramirlak, Instagram: @dramirlak

Copyright © 2019 by the American Society of Plastic Surgeons