title: Infraorbital nerve dehiscence: the anatomic cause of maxillary sinus "vacuum headache"?
abstract: Vacuum disorders of the paranasal sinuses are well described. Patients with facial pain in the distribution of the infraorbital nerve are often labelled as suffering from a "vacuum maxillary sinusitis" and empirically treated by intranasal antrostomy. A variety of mechanisms have been postulated for the production of symptoms in this condition, but all ignore the fact that the maxillary sinus is a relatively insensitive structure. This article introduces a dehiscence of the bony infraorbital nerve canal within the antrum as an anatomic variant and suggests that it may provide the anatomic basis for vacuum sinusitis in the presence of a small natural ostium. Definitive diagnosis is made by outpatient antroscopy, and surgical treatment takes the form of a middle or inferior meatal antrostomy. Persistent symptoms may benefit from an infraorbital neuropexy to provide added protection to the exposed nerve.
authors.affiliation: ENT Department, Radcliffe Infirmary, Oxford, England.
authors.forename: H B
authors.initials: HB
authors.lastname: Whittet
mesh_terms: D000368:Aged; D002102:Cadaver; D003389:Cranial Nerve Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D004724:Endoscopy; D005157:Facial Pain / Q000209:etiology*; D006801:Humans; D008442:Maxillary Nerve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000379:methods; D014057:Tomography, X-Ray Computed