Infraorbital Nerve Decompression Surgery (update)

Though I would give an update, as I have a strange case that at the very least might interest some. Tommrow Jully 11th I will be going in to have my eye socket repaired and infraorbital nerve decompressed. While not like an MVD the reasoning is at least similar.

I have Trigeminal Neuropathic Pain, not “typical” TN. Tradional MVD and going to the skull base would not work, since my pain is the result of an old eye injury, specifically an “orbital blowout fracture”. What happens with this injury is the eye is pushed inwards, and the boney orbital floor, or roof of the maxillary sinuses is “blown out”. While this feature saves the eye itself from damage, V2 of the trigeminal nerve ( the infraorbital branch ) happens to run in a canal the eye floor. So damage can occur to the nerve there.

My pain gradually appeared after the injury, so it is likely scar tissue or fragment that eventually started to irritate the nerve. Of note my eye is actually sunken in about 2-3mm according to measurements they did. So while my scans don’t show much now this is a clear sign of injury.

Doctor described in detail the procedure… they will cut an incision inside the lower eyelid, and lift the eye to get acces to the floor of the orbit. Then he will explore the nerve and remove and scar tissue, adhesesion or fragments that might be impinging on the nerve (sort of like the traditional MVD). The fracture will be repaired, and after than there will protective sheet places over the nerve.

This procedure while not that rare, there is not much documented on it, especially late repairs involving "neuralgias". There are no real “odds”, but both the doctor and I are hopefull if the nerve can be freed there at least a chance of recovery.

Something similar was documented here.

http://bopss.org/plugins/abstracts/view_abstract.php?abs_id=207

The surgery itself is relative “safe” and nowhere near as invasive as say an MVD. It’s an Outpatient procedure around 2-3 hours. My hope in my case the nerve is not damaged persay, but just have mild compression and once that is released I get some relief!

WoW JoeE, thanks for the informative explanation! So interesting…
Sounds like a delicate procedure, here’s to a positive surgical experience with a great outcome offering you long lasting relief! : )
Please check in when you’re feeling up to it to let us know how it went!
All the best!
(( hugs )) Mimi

JoeE,

Hoping everything goes perfectly for you tomorrow and you find great relief! Thank you for sharing information and how this is done.

Stay positive! Will say a prayer for you! D

Hope everything goes well…thinking about you tomorrow…keep us posted

Good luck Joe, hope everything goes well and you are not in too much pain after the surgery.
Hoping you will soon be pain free.

Hugs trish

Wishing you great success and a speedy recovery

I really hope all goes well for you. Also, a quick recovery!

Hi All,

Thank for all the prayers and wish’s, means a lot

Long story short…. procedure did not go as planned originally, but the surgeon did find scar tissue entrapping, compressing the nerve. Feel somewhat vindicated but it's bittwesweet to finally know that was the problem. Not sure of the details as it was all kind of a blur, but from what I recall talking about that would be removed and steroid given around the nerve to prevent it from building up again.

The left side of my face is almost completely numb, but that was to be expected when you manipulate the nerve like that so I take it as a good sign. Still get some twinges, creepy feeling of pain but very tough to tell what is happening with the numbness. One case I read it took the person 4 months for relief after an operation like this, so like the more known MVD the nerve has a while to heal before I can say anything definitive.

Recovery from the procedure itself is going very well. I I can walk around and even eat. Still feel very tried and a little woosy. I will post more later this week when things change

Thanks again and wish everyone more pain free days!

Yes, well actually they feel like they are inside lower the eyelid. Not painful, just feels like an eyelash or something in there. I think they are the dissolvable kind. Since it's inside there would be any outside scaring, though I honestly couldn't care less about my appearance. I'd take a gnarly skin scar across my face and trade it for no facial pain!

Also I have some eye safe antibiotic stuff to rub on the eyelid.

Wow,thanks for the great explanation of what was going to happen and how it all went down. I hope you get relief and heal quickly. All the best.

Oh yeah, lots of bruising and swelling. looks like I went 10 rounds with Tyson! Except I still have my ear.

Oh the stories you can tell for “what happened”, ; )
glad you are doing ok, hope as the days pass you feel better and better!
Mimi

Hi Joe

Great to hear you have your surgery and vindication, even if it didn’t go exactly as planned. Wishing you continued recovery.
Got any paintings planned?
Bes
Bellalarke

Hi joe,
Thanks for the update, hope you are being spoilt and the recovery continues to go well.

Take care, I am sending you gentle hugs and healing thoughts.
Trish

Thanks All,

Feel about the same today. Face is still numb but that doesn’t bother me too much. Seems like the pain might be better but impossible to tell . I am getting a ton more twitches, tingles, twinges, etc. Those were there before so while disappointing they are still there, some say that is a sign of nerve regeneration. My only theory is I got those before because the nerve was trying to regenerated, but it was eventualy blocked by the compression or entrapment, . Now hopefully they can regenerate fully.

Bellalarke,

I did start a painting a while back. We have a park here with a walkway on a breakwall next to the Lake. Lake Erie being so shallow we get huge waves. Since, the lake is so large the water goes to the horizon, so it basically looks like you’re at the ocean. Anyway I was walking during sunset and there was a small storm that past causing huge waves, but the distance was clear, creating this odd transition of dark blue to pink then to yellow in the sky. Combined with the waves it was quite a site, so I am painting that. Have the background done, just haven’t got around to finishing. Been playing more guitar lately, feel like I’m turning into one of those hippie types! Funny cause before all this I didn’t have an inch of artist or creativity in me.

Hi All

Slow progress. What has me somewhat hopeful is the neuralgic like twinges seems to have died down a bit. Still there unfortunately. The pain, tinginging, and weird sensation are also more localized to the surgical site. Primary sensation is pain and heaviness right beneath the eye. If I brush it it sets of some tingling. Also feels like the cheek is not attached and just kind of floating…., just strange!

Seems I am getting less bad sensations on the nose and lower lip. But still get a weird twinge in the nose every once in a while. Numbness is a little better in those area’s as well, and has improved a bit overall.

Bruising and swelling are still pretty bad. That combined with the antibiotics’ I need to apply to the eyelid (which are actually supposed to get into the eye)pretty much have me down to one eye.

Also to note I am on Nortriptyline 70mg a day (I split it 25 morning 35 night) and Lyrica 150mg 2x daily. Also taking sublingual b12, and alpha lipoic acid several times a day,. Throw in some Magnisum and Vitamin E , and fish oil for good measure.

Well I’m going to take some oxy and head to bed! Thanks Again for all the prayers and Well wishes.

Hi Joe,
Good to hear from you and I hope things start improve a little quicker.
Hope you are able to get some sleep and tomorrow is a pain free day.

Hugs trish

Hi Joe

How are you doing today? Still some progress? All the sensations you describe, especially the floating cheek, sound wearisome. Hope it gets a bit better everyday.

Sorry I didn’t respond to you sooner, been very happily helping daughter with new baby-:slight_smile:

I loved the way you described the sunset after the storm along Lake Erie, very evocative. So if you didn’t have an inch of artistry in you before all this, you’ve got a mile now! I’d really like to see that painting when you get it done (in fact your description makes me want to see your view of the lake itself). It’s a good thing to think about while you recover. Take that eye that isn’t seeing outward and turn it inward and practice how you’ll finish the painting.

Wishing you steady recovery and fun painting.

Peace and Happiness
Bellalarke

Hi All

Thanks again for the worlds of encouragement. Very slow progress. Swelling has died down a tinch. Still get an occasional neuralgic like “twinge” mainly on the nose, but then it doesn’t seem to amount to much. Hoping it’s just the brain playing tricks or the last dying gasp of the nerve.

Pain, numbness, and tingling have retreated a bit too, mainly under my eye where I have the swelling and bruising. Of interest the last couple of days I had “Tinels sign”, where if I lightly press on the cheek, the whole area of numbness would tingle… This is supposed to be a sign of nerve regeneration . Seems less of that today but might be because the areas that were numb yesterday have innervated. Most c case info I have read has the numbness residing for 1-3 weeks. Within that time will likely be the big tell if it worked, if the tingling and pain go away with the numbness.

Bellalrke

Sounds very joyful to help out with the grand-kids! No apologies needed.

Our Lake is quite nice, but has its issues. Most of the land near the lake is either private or industrial in nature, so that really stops tourist or public development. There are a small few beach’s, but they are only usable in July and August really. . We do have some nice islands though that retains some natural splendor. . Really feel the whole region has underutilized the lake, but my community has done a great job with the little public land that there is.

Now up where you are in the Pacific northwest and Vancouver/BC area has always been on my short list of places to visit. I like places that aren’t too hot or too cold, don’t mind rain or clouds, and love big trees and nature. I have a friend who moved to Whidbey Island there on the straight, and that’s certainly one of the first places I’d like to go to enjoy if I got rid of this infernal nagging pain. Well, Disney World might be first, hehe.

Hi Joe,
Good to hear from you.
Although the progress is slow it is good to hear there are positive signs which sound promising. I hope you are taking it easy and I shall continue to send you healing thoughts.
Take care
Hugs Trish