Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 31;13(10):e0206642.
doi: 10.1371/journal.pone.0206642. eCollection 2018.

Axon numbers and landmarks of trigeminal donor nerves for corneal neurotization

Eva Györi  1 , Chieh-Han John Tzou  1 , Wolfgang J Weninger  2 , Lukas Reissig  2 , Ursula Schmidt-Erfurth  3 , Christine Radtke  1 , Roman Dunavoelgyi  3
Affiliations

Axon numbers and landmarks of trigeminal donor nerves for corneal neurotization

Eva Györi et al. PLoS One. .

Erratum in

Abstract

Purpose: Corneal anesthesia leads to chronic corneal injury. This anatomical study characterizes the donor nerve branches of the supratrochlear and supraorbital nerves used for corneal neurotization.

Methods: In 13 non-embalmed cadavers, the supratrochlear and supraorbital nerves were dissected and distances to anatomical landmarks measured. Cross-sections of supratrochlear and supraorbital donor nerves were harvested and histomorphometrically analyzed to assess the number of myelinated axons.

Results: The donor axon counts were 3146 ± 1069.9 for the supratrochlear and 1882 ± 903 for the supraorbital nerve distal to the supraorbital notch. The supratrochlear nerve was dissected on the medial upper eyelid 2 cm lateral to the facial midline and the branch of the supraorbital nerve 1 cm medial to the mid-pupillary line.

Conclusion: The supraorbital and supratrochlear branches of the trigeminal nerve are potent donor nerves for corneal neurotization in the treatment of neuropathic keratopathy and can be reliably dissected using anatomical landmarks.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Anatomical landmarks.
The facial midline (solid arrow), the medial canthus (dashed arrow) and the mid-pupillary line (dotted arrow) were used as landmarks to provide guiding distances for donor nerve branch dissection of the supraorbital and supratrochlear nerves in this anatomical study.
Fig 2
Fig 2. Neurotization of the anesthetic cornea using a sural nerve graft and supratrochlear donor nerve.
Cadaveric dissection to neurotize the right cornea using the contralateral supratrochlear nerve as a donor, which is dissected through a small skin incision on the upper eyelid. A subcutaneous tunnel connects the donor and recipient side (A). The sural nerve is used as an autologous nerve graft and pulled through the to the superior fornix with a Wright Fascia Needle (B). The fascicles of the sural nerve graft are separated (C) and tunneled under the conjunctiva (D). The 4 to 5 fascicles are placed around the limbus and sutured to the sclera using 10–0 Nylon interrupted sutures (E).
Fig 3
Fig 3. Donor nerve branch dissection using anatomical landmarks.
The donor branch of the supraorbital nerve distal to the supraorbital notch accessed through a supraciliary incision and found approximately 1 cm medial to the mid-pupillary line (A). The supratrochlear nerve branch was located 2 cm lateral to the facial midline and dissected through a small transverse incision on the medial upper eyelid (B). The sketch on the left side displays the anatomical landmarks (see Fig 1).
Fig 4
Fig 4. Nerve biopsies.
Cross-sections of nerve biopsies of the supratrochlear nerve (A), the supraorbital nerve (B) and the sural nerve graft (C) were analyzed histomorphometrically to determine the myelinated axon counts.
See this image and copyright information in PMC

References

    1. Bonini S, Rama P, Olzi D, Lambiase A. Neurotrophic keratitis. Eye (Lond). 2003;17(8):989–95. 10.1038/sj.eye.6700616 . - DOI - PubMed
    1. Ramaesh K, Stokes J, Henry E, Dutton GN, Dhillon B. Congenital corneal anesthesia. Surv Ophthalmol. 2007;52(1):50–60. 10.1016/j.survophthal.2006.10.004 . - DOI - PubMed
    1. Terzis JK, Dryer MM, Bodner BI. Corneal neurotization: a novel solution to neurotrophic keratopathy. Plast Reconstr Surg. 2009;123(1):112–20. 10.1097/PRS.0b013e3181904d3a . - DOI - PubMed
    1. Muller LJ, Marfurt CF, Kruse F, Tervo TM. Corneal nerves: structure, contents and function. Exp Eye Res. 2003;76(5):521–42. Epub 2003/04/17. . - PubMed
    1. Elbaz U, Bains R, Zuker RM, Borschel GH, Ali A. Restoration of corneal sensation with regional nerve transfers and nerve grafts: a new approach to a difficult problem. JAMA Ophthalmol. 2014;132(11):1289–95. 10.1001/jamaophthalmol.2014.2316 . - DOI - PubMed

Publication types