RESUMEN
The ophthalmic, or first division (V1) of the trigeminal nerve, is the smallest of the three divisions and is purely sensory or afferent in function. It supplies sensory branches to the ciliary body, the cornea, and the iris; to the lacrimal gland and conjunctiva; to portions of the mucous membrane of the nasal cavity, sphenoidal sinus, and frontal sinus; to the skin of the eyebrow, eyelids, forehead, and nose; and to the tentorium cerebelli, dura mater, and the posterior area of the falx cerebri. At first glance, one might not expect one interested in the diagnosis and treatment of orofacial pain and temporomandibular joint disorders to have a need to be concerned with the ophthalmic division. Although much of this division's influence is dedicated to structures within the orbit, nose, and cranium, still, the ophthalmic division may be afflicted with a lesion or structural disorder which can cause all sorts of orofacial pain. Ignorance of this or any portion of the trigeminal nerve will lead to diagnostic and therapeutic failures. In this, the second of four (4) articles concerning the trigeminal nerve, the first division of this vast cranial nerve will be described in detail.
Asunto(s)
Nervio Oftálmico/anatomía & histología , Cuerpo Ciliar/inervación , Conjuntiva/inervación , Córnea/inervación , Enfermedades de los Nervios Craneales/complicaciones , Duramadre/anatomía & histología , Cejas/inervación , Párpados/inervación , Dolor Facial/etiología , Frente/inervación , Seno Frontal/inervación , Humanos , Iris/inervación , Aparato Lagrimal/inervación , Membrana Mucosa/inervación , Cavidad Nasal/inervación , Neuronas Aferentes/fisiología , Nariz/inervación , Nervio Oftálmico/fisiología , Seno Esfenoidal/inervación , Nervio Trigémino/anatomía & histologíaRESUMEN
The coronal incision forehead lift became a component of the face-lift procedure 35 years ago and increased the cosmetic benefit for the facial aesthetic surgery patient. Later, this enhanced cosmetic effect achieved from eyebrow resuspension was complemented by treatment of the glabellar skin lines by modifying corrugator supercilii and procerus muscle function through the same coronal incision. In recent years, newer procedures for treating the corrugator supercilii and procerus muscles by using endoscopy or limited incision techniques have eliminated the need for the coronal incision. With these newer techniques has come a renewed interest in the surgical anatomy of the muscle complex that acts on glabellar skin. This study was designed to examine the current understanding of the anatomy of these muscles and to resolve misconceptions and controversy concerning them. Fresh cadaver dissections and simulated muscle action studies done on the glabellar musculature of four specimens were correlated with nerve blockade studies performed in 10 subjects on the temporal and zygomatic branches of the facial nerve. The presence of the depressor supercilii muscle as a distinct entity was confirmed. The little-appreciated oblique head of the corrugator supercilii muscle was identified. The conclusions from this study suggest that the transverse head of the corrugator supercilii muscle produces the vertical component of the glabellar skin line and also contributes to the formation of the oblique component of the glabellar skin line. The oblique head of the corrugator supercilii muscle, the depressor supercilii muscle, and the medial head of the orbital portion of the orbicularis oculi muscle all appear to depress the medial head of the eyebrow and contribute to the formation of the oblique glabellar skin line. The nerve block study provided evidence that the zygomatic branch of the facial nerve supplies the three medial eyebrow depressor muscles, which opens the possibility for future nerve ablation techniques to control the action of the medial eyebrow depressor muscle group. This nerve block study also supports the concept of "physiologic" elevation of the medial eyebrow as an effective component of foreheadplasty.
Asunto(s)
Blefaroplastia/métodos , Músculos Faciales/patología , Frente/patología , Ritidoplastia/métodos , Adulto , Anciano , Cejas/inervación , Cejas/patología , Cejas/cirugía , Músculos Faciales/inervación , Músculos Faciales/cirugía , Femenino , Frente/inervación , Frente/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neuronas Motoras/patología , Envejecimiento de la Piel/fisiologíaRESUMEN
A patient with bilateral but asymmetrical brow ptosis is presented in whom the frontalis action on the relative position of the eyebrows could be demonstrated to obey Hering's law of equal innervation. The neurological basis for this finding is discussed, along with the implications for the surgical management of brow ptosis.
Asunto(s)
Blefaroptosis/fisiopatología , Cejas/anatomía & histología , Párpados/inervación , Nervio Facial/fisiología , Cejas/inervación , Humanos , Masculino , Músculos Oculomotores/inervaciónAsunto(s)
Cara/anatomía & histología , Cejas/anatomía & histología , Cejas/irrigación sanguínea , Cejas/inervación , Párpados/anatomía & histología , Párpados/irrigación sanguínea , Párpados/inervación , Cara/irrigación sanguínea , Cara/inervación , Músculos Faciales/anatomía & histología , Frente/anatomía & histología , Frente/irrigación sanguínea , Frente/inervación , Humanos , Maxilar/anatomía & histología , Maxilar/irrigación sanguínea , Maxilar/inervación , Músculos Oculomotores/anatomía & histología , Órbita/anatomía & histología , Órbita/irrigación sanguínea , Órbita/inervación , Envejecimiento de la Piel/patologíaRESUMEN
PURPOSE: To report three patients with superficially invasive crateriform squamous proliferations of periocular tissue. METHODS: The authors identified three patients with superficially invasive periocular tumors that had clinical features of keratoacanthoma. Clinical histories, radiographs, and surgical pathologic specimens were reviewed. RESULTS: All three tumors arose over several weeks, had a crateriform configuration, and exhibited superficial invasion of underlying tissues, including perineural invasion and infiltration into skeletal muscle. All three tumors were classified as invasive keratoacanthoma. One tumor exhibited late perineural extension into the cavernous sinus and convincing histologic features consistent with squamous cell carcinoma. CONCLUSION: The clinical importance of recognizing invasive keratoacanthoma is that although the tumor has the potential for spontaneous involution, locally aggressive behavior with deep perineural invasion is possible. This tumor is considered to represent a variant of squamous cell carcinoma. The authors recommend complete surgical excision of crateriform squamous proliferations with frozen section control of margins of resection.