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Infraorbital foramen location in the pediatric population: A guide for infraorbital nerve block
Matthew J Zdilla1,2,3, Michelle L Russell1, Aaron W Koons1
1Department of Natural Sciences and Mathematics, West Liberty University, West Liberty, WV, USA.
Insights
The infraorbital foramen is consistently located near the nasospinale-to-jugale midpoint in pediatric patients. This finding aids in optimizing infraorbital nerve blocks for procedures like cleft lip repair.
Area of Science:
- Anatomy
- Pediatric Medicine
- Pain Management
Background:
- Infraorbital nerve blocks are crucial for managing postoperative pain in cleft lip repair.
- Accurate identification of the infraorbital foramen is essential for effective nerve blocks.
- Limited data exists on infraorbital foramen location in the pediatric population.
Purpose of the Study:
- To determine the location of the infraorbital foramen in pediatric individuals.
- To establish a reliable landmark for infraorbital nerve block procedures in children.
Main Methods:
- Analysis of 152 infraorbital foramina in dry crania from fetal to 18 years old.
- Measurement of foramen location relative to the nasospinale-jugale midpoint.
- Subdivision into fetal/infant, child, and adolescent age groups.
Main Results:
- The infraorbital foramen averaged within 2 mm of the nasospinale-jugale midpoint across all pediatric age groups.
- Specific positional tendencies (medial, superomedial, superior/superolateral) were observed relative to the midpoint in different age cohorts.
Conclusions:
- The nasospinale-jugale midpoint serves as a practical landmark for locating the infraorbital foramen in pediatric patients.
- This anatomical data can enhance the precision of infraorbital nerve blocks, particularly in resource-limited settings.
- Improved nerve block techniques can optimize pain management for pediatric cleft lip surgery.
Background:
Infraorbital nerve blocks are often performed for the management of postoperative pain associated with cleft lip correction. Infraorbital nerve block procedures depend on the identification of the infraorbital foramen; however, there is little information regarding the infraorbital foramen location in the pediatric population.
Aims:
The aim of this study was to identify the location of the infraorbital foramen in the pediatric population relative to a midpoint between the nasospinale and jugale.
Methods:
The study assessed the location of 152 infraorbital foramina relative to a midpoint between the nasospinale and J on dry crania. Crania were from individuals ranging in age-at-death from 6-month fetal to 18 years. The population was subdivided into fetal/infant (≥6 months fetal age-<2 years), child (≥2-<12 years), and adolescent (≥12-≤18 years) groups for comparison.
Results:
The average distance of the infraorbital foramen from the nasospinale-to-jugale midpoint was 1.55 ± 0.78 mm (Mean ± SD) in the fetal/infant group, 0.80 ± 0.91 mm in the child group, and 1.31 ± 1.68 mm in the adolescent group. Furthermore, infraorbital foramina tended to be located medial to the nasospinale-to-jugale midpoint in the fetal/infant population, directly upon or superomedial to the nasospinale-to-jugale midpoint in the child population, and directly upon or superior/superolateral to the nasospinale-to-jugale midpoint in the adolescent population.
Conclusions:
The infraorbital foramen was located within 2 mm, on average, from the nasospinale-to-jugale midpoint regardless of age group. Therefore, the nasospinale-to-jugale midpoint may serve as useful means of identifying the location of the infraorbital foramen in the pediatric population and aid in optimizing infraorbital nerve block procedures. The information in this report is valuable in general, but may be particularly useful in developing countries where there is a lack of ultrasound training and availability for health care providers; or places where infraorbital nerve block may be the sole anesthetic modality for cleft lip surgery, even among adolescent patients.
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