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Department of Anesthesiology; Clinique de la Baie; Villedieu, France; xdldl{at}wanadoo.fr
To the Editor:
Bernard and Péréon (1) used the blink reflex to identify the infraorbital branch of the trigeminal nerve to provide regional anesthesia for elderly patients undergoing minor surgery of the nose, cheek, or lower eyelid. The infraorbital branch is a strictly sensory nerve, and only results in a motor response through its bulbar connection between trigeminal and facial nerves.
Blind infiltration of local anesthetic solution around the cutaneous emergence of infraorbital nerve would lead to the same surgical comfort. Superficial face surgery is usually made after skin infiltration with local anesthetics, and I am not convinced of a major difference with infraorbital block (2).
Physiologically, the authors do not bring additional evidence to support their notion that the blink reflex is the neurophysiologic motor response to that stimulation, such as that used by laboratories as a diagnostic tool for bulbar or trigeminal pathologies. Laboratory studies show that blink reflex response is bilateral (3). Using the technique of Bernard and Péréon, I noticed clear homolateral blink reflex. Could other mechanisms explain such a difference?
REFERENCES
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