CPT® Code 64734

1. Indications

Transection or avulsion of the infraorbital nerve is indicated for the treatment of chronic pain conditions that may arise from nerve-related issues. The following are specific indications for this procedure:

• Chronic Pain Syndromes Patients experiencing persistent pain in the areas innervated by the infraorbital nerve, which may include the lower eyelid, side of the nose, and upper lip.
• Neuropathic Pain Conditions characterized by nerve damage or dysfunction that leads to abnormal pain sensations, often unresponsive to conservative treatments.
• Facial Pain Disorders Situations where traditional pain management strategies have been ineffective in alleviating facial pain associated with the infraorbital nerve.

2. Procedure

The procedure for transection or avulsion of the infraorbital nerve involves several key steps to ensure proper identification and management of the nerve. The following procedural steps are typically followed:

• Step 1: Incision An incision is made in a natural skin crease along the infraorbital rim to minimize scarring and provide access to the infraorbital nerve. This incision allows the surgeon to approach the nerve either from an extraoral perspective.
• Step 2: Identification of the Nerve Once the incision is made, soft tissues are carefully dissected to expose the infraorbital canal. The infraorbital nerve is identified as it exits the infraorbital canal, ensuring that the correct anatomical structure is targeted for the procedure.
• Step 3: Nerve Isolation The infraorbital nerve is isolated using a nerve hook or similar instrument. This step is crucial to prevent damage to surrounding tissues and to facilitate the transection or avulsion process.
• Step 4: Transection or Avulsion The actual transection or avulsion of the nerve is performed using techniques similar to those used in other nerve procedures. The nerve may be grasped and divided proximally, or it may be avulsed by twisting it over a hemostat, which typically results in severing the nerve within the foramen. Alternatively, the nerve may be stretched, ligated, and divided first distally and then proximally, allowing the proximal end to retract into the foramen.

3. Post-Procedure

After the transection or avulsion of the infraorbital nerve, patients may require specific post-procedure care to ensure proper healing and recovery. This may include monitoring for any signs of complications, such as infection or excessive bleeding. Patients are typically advised on pain management strategies, which may include medications to manage discomfort following the procedure. Additionally, follow-up appointments may be scheduled to assess the effectiveness of the procedure in alleviating pain and to monitor the healing process. It is important for patients to adhere to any postoperative instructions provided by their healthcare provider to optimize recovery outcomes.