"Microanatomy of sensory nerves in the upper eyelid: A cadaveric anatomical study”

Background: Plastic surgery requires detailed knowledge of upper eyelid anatomy, but few authors have sufficiently described the specifics of upper eyelid nerve anatomy. This study aimed to provide a thorough description of sensory nerve anatomy in the upper eyelid and to propose considerations for upper eyelid surgery. Methods: Sixteen orbits were dissected from sixteen fixed, adult human cadavers. Microscopically, we identified the main trunks of the infratrochlear, supratrochlear, and supraorbital nerves and all branches that projected toward the upper eyelid. The number, size, and distribution of nerve branches were recorded. Results: The branches of the infratrochlear, supratrochlear, and supraorbital nerves covered a wide range in the upper eyelid. The mean numbers of branches/nerve were 1.6 ± 1.2, 3.2 ± 1.5, and 2.6 ± 1.4, respectively. The branches of the infratrochlear nerve were distributed throughout the medial area of the upper eyelid. Those of the supratrochlear nerve were distributed throughout the medial and central areas, and the palpebral branches of the supraorbital nerve were distributed throughout the central and lateral areas of the upper eyelid. The lateral branches of the supraorbital nerve and the cutaneous branches of the lacrimal nerve were distributed in the lateral region of the orbit. Conclusions: We show that upper eyelid sensation is transmitted mainly by the supratrochlear and supraorbital nerves, and we provide a map of the distribution of upper eyelid sensory nerves. This precise anatomical knowledge about upper eyelid sensory nerves will facilitate pain control and help minimize nerve injuries during surgery. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Presented at: the 25th Research Council Meeting of Japan Society of Plastic and Reconstructive Surgery, in Osaka, Japan, September 15 through 16, 2016. ACKNOWLEDGMENTS: The authors would like to thank Masako Akiyama in the URA office of Tokyo Medical and Dental University for her advice regarding statistical analyses. Corresponding author: Takuya Higashino, MD, Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan., higashino-pla@umin.ac.jp ©2018American Society of Plastic Surgeons

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