The supraorbital region revisited – an anatomic exploration of the neuro-vascular bundle with regard to frontal migraine headache

Publication date: Available online 27 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Valeria Berchtold, Hannes Stofferin, Bernhard Moriggl, Erich Brenner, Reinhard Pauzenberger, Marko Konschake
BackgroundRecent findings on the pathogenesis of frontal migraine headache support, besides a central vasogenic cause, an alternative peripheral mechanism involving compressed craniofacial nerves. Supported further 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 (STN) and supraorbital nerve (SON) were identified and their relationship to the corrugator supercilii muscle (CSM) was investigated by dissection and ultrasound. The course of both nerves was defined and the interaction of the supraorbital artery (SOA) to the SON 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 varying topography of the STN and CSM, the SON and CSM as well as the SON and SOA. Further on we provide an algorithm for ultrasound visualization of the supraorbital neuro-vascular 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, being used by the SON and STN. Third, the passage of the STN through the orbital septum.



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