Biopsy of a supraorbital nerve
Richard C. Allen, MD, PhD, FACS
This is Richard Allen at the University of Iowa. This video demonstrates biopsy of the supraorbital nerve in a patient with a history of a squamous cell carcinoma of the ipsilateral forehead. The patient now has an enlarged supraorbital nerve on imaging with concern for perineural invasion. A lid crease incision is made and dissection is carried out between the orbicularis muscle and the orbital septum to the superior orbital rim. The superior orbital rim is identified and incised with the needle tip cautery. A Freer periosteal elevator is then used to elevate the periosteum from the underlying bone. Westcott scissors are then used to dissect medially until the supraorbital neurovascular bundle is identified. Dissection is then carried out under the periosteum in the area of the supraorbital neurovascular bundle. Dissection is carried out intraorbitally to dissect the periosteum from the orbital roof. Westcott scissors are then used to excise a portion of the supraorbital nerve. Bipolar cautery is close by in order to control any potential bleeding. Vascular structures are obviously close to the supraorbital nerve so brisk bleeding could occur. The specimen is sent to the pathologist. After hemostasis is assured, the upper eyelid crease is closed with interrupted 6–0 Prolene sutures. The patient will use erythromycin ophthalmic ointment 3 times a day for a week.
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