Infra-orbital nerve
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The infraorbital nerve is a branch of the maxillary nerve, itself a branch of the trigeminal nerve (CN V). It travels through the orbit and enters the infraorbital canal to exit onto the face through the infraorbital foramen. It provides sensory innervation to the skin and mucous membranes around the middle of the face.


Structure

The infraorbital nerve is a branch of the maxillary nerve (CN V2), itself a branch of the trigeminal nerve (CN V). It travels with the
infraorbital artery The infraorbital artery is an artery in the head that branches off the maxillary artery, emerging through the infraorbital foramen, just under the orbit of the eye. Course The infraorbital artery appears, from its direction, to be the continuatio ...
and vein. It branches from the maxillary nerve in the pterygopalatine fossa and travels through the
inferior orbital fissure The inferior orbital fissure is formed by the sphenoid bone and the maxilla. It is located posteriorly along the boundary of the floor and lateral wall of the orbit. It transmits a number of structures, including: * the zygomatic branch of the m ...
to enter the orbit. It runs anteriorly along the floor of the orbit in the infraorbital groove to the infraorbital canal of the maxilla. Within the infraorbital canal it has three branches, the posterior superior alveolar nerve,
middle superior alveolar nerve The middle superior alveolar nerve is a nerve that drops from the infraorbital portion of the maxillary nerve to supply the sinus mucosa, the roots of the maxillary premolars, and the mesiobuccal root of the first maxillary molar. It is not al ...
and
anterior superior alveolar nerve The anterior superior alveolar nerve (or anterior superior dental nerve), is a branch of the infraorbital nerve, itself a branch of the maxillary nerve (V2). It branches from the infraorbital nerve within the infraorbital canal before the infraorbi ...
. After traversing the canal it emerges onto the anterior surface of the maxilla through the infraorbital foramen. Here, it divides into its terminal branches; palpebral, nasal and
superior labial The superior labial artery (superior labial branch of facial artery) is larger and more egregious than the inferior labial artery. It follows a similar course along the edge of the upper lip, lying between the mucous membrane and the orbicularis ...
.


Branches

Within infraorbital canal from proximal to distal: * posterior superior alveolar nerve. *
middle superior alveolar nerve The middle superior alveolar nerve is a nerve that drops from the infraorbital portion of the maxillary nerve to supply the sinus mucosa, the roots of the maxillary premolars, and the mesiobuccal root of the first maxillary molar. It is not al ...
. *
anterior superior alveolar nerve The anterior superior alveolar nerve (or anterior superior dental nerve), is a branch of the infraorbital nerve, itself a branch of the maxillary nerve (V2). It branches from the infraorbital nerve within the infraorbital canal before the infraorbi ...
. After it exits the infraorbital foramen: * palpebral branches. * nasal branches. *
superior labial branches The superior labial branches (labial branches), the largest and most numerous, descend behind the quadratus labii superioris, and are distributed to the skin of the upper lip, the mucous membrane of the mouth, and labial glands. They are joined, ...
. The palpebral branches ascend deep to the orbicularis oculi and pierce the muscle to supply the skin of the lower eyelid. The nasal branches supply the skin of the side of the nose and the moveable part of the nasal septum. The
superior labial branches The superior labial branches (labial branches), the largest and most numerous, descend behind the quadratus labii superioris, and are distributed to the skin of the upper lip, the mucous membrane of the mouth, and labial glands. They are joined, ...
descend deep to the levator labii superioris to supply the skin of the anterior cheek and upper lip.


Function

The infraorbital nerve provides sensation to the skin of the
lower eyelid An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. The human eyel ...
, the side of the nose, the moveable part of nasal septum, the anterior cheek, and part of the upper lip. It does not provide motor supply to any muscles.


Clinical significance


Infraorbital nerve block

The infraorbital nerve is often blocked with local anesthetic to induce analgesia. This may be due to chronic pain, or during dental or surgical procedures of the face such as for the management of postoperative pain associated with cleft lip correction. Zdilla, M. J., Russell, M. L., & Koons, A. W. (2018). Infraorbital foramen location in the pediatric population: A guide for infraorbital nerve block. Paediatric Anaesthesia, 28(8), 697–702. https://doi.org/10.1111/pan.13422 The needle is inserted (aiming medially) near to the infraorbital foramen, which can be palpated. The nerve may be blocked using either a transcutaneous or intraoral approach.


Trigeminal neuralgia

The infraorbital nerve can be implicated in trigeminal neuralgia, where patients have severe
orofacial pain Orofacial pain is a general term covering any pain which is felt in the mouth, jaws and the face. Orofacial pain is a common symptom, and there are many causes. Orofacial Pain (OFP) is the specialty of dentistry that encompasses the diagnosis, ma ...
.


Orbital fracture

A fracture of the floor of the orbit can injure the infraorbital nerve resulting in anesthesia in its sensory distribution.


References

{{Authority control Maxillary nerve Nose