64734 Transection or avulsion of; infraorbital nerve

Name of the Procedure:

Transection or Avulsion of the Infraorbital Nerve

Summary

The transection or avulsion of the infraorbital nerve is a surgical procedure that involves cutting or completely removing a portion of the infraorbital nerve, which provides sensation to the midface area, to relieve chronic pain or other nerve-related issues.

Purpose

This procedure addresses chronic facial pain, trigeminal neuralgia, or nerve damage that cannot be managed through less invasive treatments. The goal is to alleviate pain and improve the patient's quality of life.

Indications

• Persistent and severe facial pain unresponsive to medication
• Trigeminal neuralgia affecting the infraorbital nerve
• Facial nerve injuries causing intractable neuropathic pain
• Patients with no significant response to other conservative treatments

Preparation

• Patients may need to fast for at least 8 hours before the procedure.
• Pre-procedure assessments might include imaging studies such as MRI or CT scans, and nerve conduction studies.
• Preparation may involve adjustments in current medications, especially blood thinners.

Procedure Description

1. The patient is positioned, and local or general anesthesia is administered.
2. The surgeon makes a small incision in the cheek area to expose the infraorbital nerve.
3. The nerve is carefully identified and either cut (transection) or removed (avulsion).
4. The incision is then closed with sutures.
5. The patient is monitored as they recover from the anesthesia.

Tools used include scalpels, nerve stimulators, and fine surgical instruments. The procedure typically involves local anesthesia, but general anesthesia may be used depending on the patient's needs.

Duration

The procedure usually takes 1-2 hours.

Setting

This procedure is typically performed in a hospital or surgical center.

Personnel

• Surgeon (typically a neurosurgeon or a specialist in maxillofacial surgery)
• Anesthesiologist or nurse anesthetist
• Surgical nurses and assistants

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Temporary or permanent numbness in the affected area
• Potential for incomplete pain relief or recurrence of pain
• Rarely, damage to nearby structures or nerves

Benefits

The expected benefit is significant or complete relief from chronic pain, potentially leading to improved quality of life. Pain relief might be noticed immediately after surgery or within a few days.

Recovery

• The patient may experience swelling and bruising.
• Pain at the surgical site can be managed with medications.
• Most patients can resume normal activities within 1-2 weeks.
• Follow-up appointments are necessary to monitor healing and address any concerns.

Alternatives

• Medication management with anticonvulsants or antidepressants
• Non-surgical interventions like nerve blocks or radiofrequency ablation
• Physical therapy and lifestyle modifications
• Each alternative has its pros and cons; for instance, medications might offer temporary relief without surgical risks but may require long-term use and have side effects.

Patient Experience

Patients may feel drowsiness or discomfort initially due to anesthesia. Postoperative pain is managed with medications, and most discomfort subsides within a few days. Swelling and numbness in the treated area are common and typically short-term.