Purpose

To report the outcomes of surgical repair of frontal nerve injuries in the periorbital region at a tertiary referral centre

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Methods

Retrospective chart review of patients with frontal nerve injuries in the periorbital region, repaired at a tertiary referral centre during June 2016 to May 2026 was done. The improvement in facial symmetry and nerve function was assessed by the Sunnybrook Facial Grading System for facial palsy. The surgical techniques of nerve repair, adjunctive procedures and the time needed to improve the nerve function were also analyzed.

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Results

10 patients were included in this audit (06:males, 04:females) with mean age: 44.3 years (Range: 15-73 years; SD: 20.45 years). Periorbital trauma was the commonest cause (90%) of nerve injury. 01 patient developed developed nerve injury following a cosmetic brow lift procedure. Frontal branch of the facial nerve was affected in all; in addition supraorbital nerve and zygomatic branch of facial nerve were involved in 02 patients. 80% patients complained of brow ptosis and the inability to raise the affected eyebrow (Sunnybrook score:1/5). 02 patients had loss of sensation in the forehead; 01 developed reduced corneal sensation with lagophthalmos. Direct coaptation of the damaged nerve ends were done in 09 patients; a neuro-fascicular flap was raised to repair the damaged nerve in 01 patient. The time lag between injury and repair ranged from 02 days to 18 months. A positive Tinel’s sign was elicited in 08 patients. Complete and partial recovery of nerve function post repair was noted in 07 ( Sunnybrook score 4/5 to 5/5) and 02 patients (Sunnybrook score 2/5 to 3/5) respectively; One patient did not improve. The mean duration for recovery of the nerve function post repair was 8.6 months (Median:10 months; Range: 2-15 months)

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Conclusion

Frontal branch of facial nerve is vulnerable to injury in trauma to the periorbital area. Subtle clinical findings are often missed; hence repair of the damaged nerves is often neglected during the primary trauma management. Early nerve repair should be attempted; however delayed repair within 18 months after injury may still be beneficial.

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Additional Authors

First name	Last name	Base Hospital / Institution
Dario	Leto	Queen Victoria Hospital, NHS Foundation Trust, UK
Ruben	Kannan	Queen Victoria Hospital, NHS Foundation Trust, UK
Charles	Nduka	Queen Victoria Hospital, NHS Foundation Trust, UK
Raman	Malhotra	Queen Victoria Hospital, NHS Foundation Trust, UK

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