Copyright © 2017 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. that hypoesthesia occurred in 32.9% of 301 patients with orbital floor fracture. Also, the most common postoperative complication was hypoesthesia in 34.2%. 7 Rosado and de Vicente 8 reported that the most frequent sequelae of 314 patients with orbital fractures were hypoesthesia in 24.5% of patients. The etiology of traumatic sensory dysfunction of the trigeminal nerve branches is presumed as nerve compression due to dislocated bone fragments, nerve traction from a displaced fracture, transection of the nerve, nerve manipulation by the fracture reduction, and bony proliferation along a healing fracture site. 10 Hypoesthesia itself is not a major disability. However, persistent hyperesthesia can be dis- abling. 6 Although post-traumatic hypoesthesia of the infraorbital nerve is common, persistent hyperesthesia is rare. 4,5 Bailey et al 4 described chronic infraorbital hyperesthesia by compression in the infraorbital canal. Soft tissue adhesion and bony impingement to the infraorbital nerve were the causes of the hyperesthesia. Our patients had developed a very specific complaint of pro- gressive hyperesthesia in surgically repaired orbital fracture patients. In patient 1, the scar tissue formation and bony proliferation are responsible for persistent hyperesthesia after fracture reduction. Boyne reported, in monkeys, that disruption of the inferior alveolar canal following tooth extraction leads to bony proliferation during the healing process, which subsequently causes narrowing of the diameter of the canal and damage to the inferior alveolar nerve. 11 Hence, in patient 1, a similar condition of impaired inferior orbital sulcus by the fracture was possible. 1 Tiny irregular shaped bones at the fracture site are likely to leads to bony proliferation during healing process and it could compress the infraorbital nerve. When inserting the alloplastic implant, the surgeon need to get clean up the tiny bone pieces surrounding the infraorbital nerve. It could prevent the nerve from being compressed by the scar tissue and bony proliferation. Recently, resorbable alloplastic implants have been used in the reconstruction of orbital fracture. The dense fibrous capsule encapsulated alloplastic implant. 12 In patient 2, fibrotic band-like scar tissue spread through the holes of the mesh that could be happen an adhesion in the infraorbital nerve. It could cause the infraorbital nerve to be compressed leading to hyperesthesia. Fibrotic bands between the infraorbital nerve and alloplastic implant could cause progressive hyperesthesia. We recommend that the infraorbital nerve needs to be separated enough from the alloplastic implant through a careful sharp dissection. Although complete improvement of infraorbital nerve dysfunc- tion associated with fractures is expected following surgical repair, hyperesthesia leads to a serious life-time problem, as in our patients. These were rare cases of patients who presented with hyperesthesia after reduction of orbital fracture. Clinician should perform early surgical decompression of the infraorbital nerve in patient with persistent hyperesthesia. REFERENCES 1. Bagheri SC, Meyer RA, Khan HA, et al. Microsurgical repair of peripheral trigeminal nerve injuries from maxillofacial trauma. J Oral Maxillofac Surg 2009;67:1791–1799 2. Benoliel R, Birenboim R, Regev E, et al. Neurosensory changes in the infraorbital nerve following zygomatic fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:657–665 3. Becelli R, Carboni A, Cerulli G, et al. Delayed and inadequately treated malar fractures: evolution in the treatment, presentation of 77 cases, and review of the literature. Aesthetic Plast Surg 2002;26:134– 138 4. Bailey K, Ng JD, Hwang PH, et al. Infraorbital nerve surgical decompression for chronic infraorbital nerve hyperesthesia. Ophthal Plast Reconstr Surg 2007;23:49–51 5. Tengtrisorn S, McNab AA, Elder JE. Persistent infra-orbital nerve hyperaesthesia after blunt orbital trauma. Aust N Z J Ophthalmol 1998;26:259–260 6. Jungell P, Lindqvist C. Paraesthesia of the infraorbital nerve following fracture of the zygomatic complex. Int J Oral Maxillofac Surg 1987;16:363–367 7. Bartoli D, Fadda MT, Battisti A, et al. Retrospective analysis of 301 patients with orbital floor fracture. J Craniomaxillofac Surg 2015;43:244–247 8. Rosado P, de Vicente JC. Retrospective analysis of 314 orbital fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:168–171 9. Hogenhuis LA, Bruyn GW. Periorbital pain: a clinical review. Cephalalgia 1999;19 (suppl):31–32 10. Renzi G, Carboni A, Perugini M, et al. Posttraumatic trigeminal nerve impairment: a prospective analysis of recovery patterns in a series of 103 consecutive facial fractures. J Oral Maxillofac Surg 2004;62:1341– 1346 11. Boyne PJ. Postexodontia osseous repair involving the mandibular canal. J Oral Maxillofac Surg 1982;40:69–73 12. Mauriello JA Jr, Fiore PM, Kotch M. Dacryocystitis. Late complication of orbital floor fracture repair with implant. Ophthalmology 1987;94:248–250 Giant Orf on the Nose Nurdog˘an Ata, MD,  Halil Emre Go¨g˘u¨s¸, MD,  and Selc¸uk Kilic¸, MD y Abstract: Orf is a zoonotic infectious disease caused by parapox- virus. Orf lesions are typically seen on the hand, but they have rarely been reported on the nose. Herein, the authors report a rare patient of an orf lesion on the nose of a 52-year-old man after the Muslim celebration of the feast of the sacrifice. The lesion spontaneously recovered 8 weeks after the initial appearance and showed no evidence of recurrence after 1 year of follow-up. Orf virus FIGURE 2. (A) Dense infraorbital scar tissue adhesion was demonstrated along the infraorbital sulcus via transconjunctival approach for orbital floor. The small bony spur (black arrow) was noted compressing the infraorbital nerve around its sulcus. (B) The infraorbital nerve around the infraorbital foramen of the maxillary bone was normal in appearance (black arrow). (C) The band-like dense fibrous tissue around the implant expanded through the hole of implant toward the infraorbital nerve (black arrow). (D) The fibrous bands were excised without damage to the infraorbital nerve. Brief Clinical Studies The Journal of Craniofacial Surgery  Volume 28, Number 3, May 2017 e234 # 2017 Mutaz B. Habal, MD