• J Plast Reconstr Aesthet Surg · Sep 2017

    The supraorbital region revisited: An anatomic exploration of the neuro-vascular bundle with regard to frontal migraine headache.

    • Valeria Berchtold, Hannes Stofferin, Bernhard Moriggl, Erich Brenner, Reinhard Pauzenberger, and Marko Konschake.
    • Division of Clinical and Functional Anatomy, Department for Anatomy, Histology and Embryology, Medical University of Innsbruck (MUI), Austria.
    • J Plast Reconstr Aesthet Surg. 2017 Sep 1; 70 (9): 1171-1180.

    BackgroundRecent findings on the pathogenesis of frontal migraine headache support, besides a central vasogenic cause, an alternative peripheral mechanism involving compressed craniofacial nerves. This is further supported by the efficiency of botulinum toxin injections as a new treatment option in frontal migraine headache patients.MethodsThe supraorbital regions of 22 alcohol-glycerine-embalmed facial halves of both sexes were dissected. Both the supratrochlear and supraorbital nerves (STN and SON, respectively) were identified, and their relationship with the corrugator supercilii muscle (CSM) was investigated by dissection and ultrasound. The course of both nerves was defined, and the interaction between the supraorbital artery (SOA) and SON was determined.ResultsWe discovered a new possible compression point of the STN passing through the orbital septum and verified previously described compression points of both STN and SON. Osteofibrous channels used by the STN and SON were found constantly. We described the varying topography of the STN and CSM, the SON and CSM, and the SON and SOA. Further, we provide an algorithm for the ultrasound visualization of the supraorbital neurovascular bundle.ConclusionOur data support the hypothesis of a peripheral mechanism for frontal migraine headache because of following potential irritation points: first, the CSM is constantly perforated by the SON and frequently by the STN; second, the topographic proximity between SOA and SON and the osteofibrous channels is used by the SON and STN; and third, the STN passes through the orbital septum.Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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