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Infraorbital nerve dehiscence: the anatomic cause of maxillary sinus "vacuum headache"?
1ENT Department, Radcliffe Infirmary, Oxford, England.
Abstract:
Vacuum disorders of the paranasal sinuses are well described. Patients with facial pain in the distribution of the infraorbital nerve are often labelled as suffering from a "vacuum maxillary sinusitis" and empirically treated by intranasal antrostomy. A variety of mechanisms have been postulated for the production of symptoms in this condition, but all ignore the fact that the maxillary sinus is a relatively insensitive structure. This article introduces a dehiscence of the bony infraorbital nerve canal within the antrum as an anatomic variant and suggests that it may provide the anatomic basis for vacuum sinusitis in the presence of a small natural ostium. Definitive diagnosis is made by outpatient antroscopy, and surgical treatment takes the form of a middle or inferior meatal antrostomy. Persistent symptoms may benefit from an infraorbital neuropexy to provide added protection to the exposed nerve.
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