Microanatomy of Sensory Nerves in the Upper Eyelid: A Cadaveric Anatomical Study

Microanatomy of Sensory Nerves in the Upper Eyelid: A Cadaveric Anatomical Study: No abstract available




This commentary refers to an article recently published in Plastic and Reconstructive Surgery.1 Higashino et al. dissected 16 orbits from fixed cadavers and stated that they demonstrated for the first time that the branches of the supratrochlear nerve and supraorbital nerve ranged widely in the upper eyelid, and that there was no significant difference in the number of branches derived from the supratrochlear and supraorbital nerves.



According to Whitnall’s textbook, which they did not cite, the skin of the upper eyelid is supplied mainly by palpebral branches derived from the supraorbital branch of the frontal (ophthalmic) nerve; the medial extremities of both lids are supplied by the supratrochlear and infratrochlear nerves, and the lateral extremities by the lacrimal nerve.2 In our previous study, which Higashino et al. also did not cite, the supratrochlear nerve entered the upper eyelid at the orbital margin −6.7 ± 3.1 mm (approximately one-fourth of the palpebral fissure) medial to the medial canthus and 11.9 ± 4.3 mm (approximately one-half of the eyebrow height) from the eyelid margin. The terminal branches to the eyelid margin of the supratrochlear nerve were distributed between −7.1 and −5.5 mm (approximately minus one-fourth and minus one-fifth of the palpebral fissure) medial to the medial canthus, and between 1.2 and 3.9 mm (approximately one-fifth of the eyebrow height) from the eyelid margin.3



Therefore, Whitnall and Hwang concur that the supratrochlear nerve supplies the medial extremity of the upper eyelid, rather than being widely distributed in the upper eyelid. It would be helpful if Higashino et al. could provide photographs showing the distribution of the supratrochlear nerve from the eyelid entrance point to the eyelid margin.



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ACKNOWLEDGMENT

This study was supported by a grant from the National Research Foundation of Korea (NRF2017R1A2B4005787).



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DISCLOSURE

The author has no financial interest to declare in relation to the content of this communication.



Kun Hwang, M.D., Ph.D.



Department of Plastic Surgery



Inha University School of Medicine



27 Inhang-ro, Jung-gu



Incheon 22332, Republic of Korea



jokerhg@inha.ac.kr



Facebook: pskunhwang



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REFERENCES

1. Higashino T, Okazaki M, Mori H, et al. Microanatomy of sensory nerves in the upper eyelid: A cadaveric anatomical study. Plast Reconstr Surg. 2018;142:345–353.

Cited Here...

2. Whitnall SE. Anatomy of the Human Orbit and Accessory Organs of Vision. 1932:2nd ed. London: Oxford University Press; 179–181.

Cited Here...

3. Hwang K, Wu XJ, Kim H, Kim DJ. Sensory innervation of the upper eyelid. J Craniofac Surg. 2018;29:514–517.

Cited Here...

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