1/34. Surgical treatment of paralysis of the inferior division of the oculomotor nerve.BACKGROUND: paralysis of the inferior division of the oculomotor nerve is relatively rare. Little has been written about its surgical treatment. methods: Five patients with paralysis of the inferior division of the oculomotor nerve were treated with transposition of the superior rectus muscle toward the insertion of the medial rectus muscle, transposition of the lateral rectus muscle toward the insertion of the inferior rectus muscle, and tenotomy of the superior oblique tendon in the affected eye. RESULTS: All 5 patients had a satisfactory outcome. They were free of diplopia in the primary position as of their last examination. Follow-up ranged from 3 to 10 years after surgery. CONCLUSION: paralysis of the inferior division of the oculomotor nerve can be adequately treated by simultaneous transposition of the superior rectus muscle toward the insertion of the medial rectus muscle, transposition of the lateral rectus muscle toward the insertion of the inferior rectus muscle, and tenotomy of the superior oblique tendon in the affected eye.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/34. En bloc resection of an intracavernous oculomotor nerve schwannoma and grafting of the oculomotor nerve with sural nerve. Case report and review of the literature.A case in which a left oculomotor nerve schwannoma treated by en bloc resection of the lesion and grafting of the oculomotor nerve with sural nerve is presented. Recovery of nerve function was partial, but useful and cosmetically good. The last follow-up examination performed 2 years after surgery revealed recovery of function in the elevator muscle of the upper eyelid, together with slight vertical movement of the eye.- - - - - - - - - - ranking = 0.125keywords = muscle (Clic here for more details about this article) |
3/34. Lagophthalmos: an unusual manifestation of oculomotor nerve aberrant regeneration.PURPOSE: To describe a patient with unusual findings after regeneration of the oculomotor nerve. methods: Case report. RESULTS: A 35-year-old woman developed complete right third nerve paralysis after neurosurgical ligation of internal carotid-posterior communicating and internal carotid-ophthalmic artery aneurysms. Permanent ipsilateral lagophthalmos appeared as third nerve function spontaneously recovered. CONCLUSION: Lagophthalmos may rarely develop after aberrant regeneration of the oculomotor nerve, presumably caused by co-contraction of the levator and superior rectus muscles during the Bell's phenomenon.- - - - - - - - - - ranking = 0.125keywords = muscle (Clic here for more details about this article) |
4/34. Fascicular arrangement within the oculomotor nerve MRI analysis of a midbrain infarct.The fascicular arrangement of the oculomotor nerve within the midbrain is not adequately elucidated in humans. We treated a patient with a partial oculomotor palsy who had impaired adduction and supraduction on the left side, which were attributed to an ipsilateral lacunar infarct. CT and MRI revealed a discrete lesion in the centre of the midbrain tegmentum in the rostrocaudal plane. This case suggests that the oculomotor fibres for extraocular movement are located in the middle of the the midbrain, and supports the fascicular proximity of the superior and medial rectus muscles. The fascicular arrangement of the midbrain oculomotor nerve is speculated to be pupillary component, extraocular movement and eyelid elevation in that rostrocaudal order, based on the previous reports of neuro-ophthalmological impairment and MRI findings, which are analogous to the nuclear arrangement proposed by Warwick.- - - - - - - - - - ranking = 0.125keywords = muscle (Clic here for more details about this article) |
5/34. Ocular signs due to an oculomotor intranuclear lesion: palsy of adduction and contralateral eye elevation.Reports on ocular signs of discrete oculomotor nuclear lesions have been rare. This is a case report of a patient with the sudden onset of limited adduction on the left side and bilateral elevation palsy, more pronounced on the right side. The symptoms lasted for 3 days. neuroimaging study did not reveal a responsible lesion. The patient was diagnosed as having a lacunar infarct. It is neuroanatomically established that the oculomotor subnucleus to the superior rectus muscle primarily cross-innervates the muscle. The palsy of adduction and contralateral supraduction is most plausibly explained by a partial oculomotor nuclear lesion. This patient demonstrated the intranuclear close arrangement of the nerves for the superior and medial rectus muscles. This case reminds us of the clinical importance of basic anatomy based neurological examinations in this computer orientated, high tech era.- - - - - - - - - - ranking = 0.375keywords = muscle (Clic here for more details about this article) |
6/34. Medial transposition of the lateral rectus muscle in combined third and fourth nerve palsy.Surgical treatment of combined third and fourth nerve palsy is a challenging problem in strabismology. Five of the 6 extraocular muscles are paralyzed, which leaves the lateral rectus muscle with no antagonist to counteract its activity and usually results in a maximal exotropia. The goal of surgery is to achieve orthophoria in primary position with limited ductions. Because some believe that a conventional recession-resection procedure will inevitably result in a drift back to exotropia,(1) several other methods have been proposed to treat this disorder. These include temporal mattress suture,(2) eye muscle prosthesis, (3,4) splitting and reattaching the lateral rectus muscle near the vortex veins,(5) and fixation of the eye with fascia lata.(6) Taylor(7) suggested using medial transposition of the lateral rectus muscle in a case of isolated third nerve palsy. We report the outcome of a procedure that included such a transposition for the treatment of combined third and fourth nerve palsy.- - - - - - - - - - ranking = 1.125keywords = muscle (Clic here for more details about this article) |
7/34. Myectomy of lateral rectus muscle for third nerve palsy.PURPOSE: To introduce myectomy of the lateral rectus muscle for correcting exotropia in patients with third nerve palsy. methods: The lateral rectus muscle of the paretic eye was myectomized without suturing it to the globe. This was combined with a medial rectus muscle resection and a contralateral lateral rectus muscle recession. magnetic resonance imaging was performed to observe the re-attachment of the lateral rectus muscle to the globe. RESULTS: The patient was able to fuse in the primary position without any noticeable limitation in abduction. magnetic resonance imaging showed that the lateral rectus muscle was attached to the globe through fibrous tissue. CONCLUSION: Myectomy of the lateral rectus muscle is an effective and simple procedure to accomplish a super-maximal weakening effect of abduction in patients with complete third nerve palsy.- - - - - - - - - - ranking = 1.375keywords = muscle (Clic here for more details about this article) |
8/34. Superior rectus-levator synkinesis: a previously unrecognized cause of failure of ptosis surgery.PURPOSE: To describe a previously unreported type of ptosis associated with abnormal synkinesis between the superior rectus muscle and the levator palpebrae superioris. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Seven cases with congenital or longstanding unilateral ptosis presenting to a regional, tertiary referral, oculoplastic service. Six of these cases were seen within a period of 2 years. methods: Detailed observations of eyelid, ocular, and pupil movements of both eyes were performed before the planning of ptosis surgery anterior levator resection. MAIN OUTCOME MEASURES: Magnitude of ptosis and its variation with the position of gaze. RESULTS: Ptosis present in the primary position disappeared or markedly reduced with upgaze so that measurements of levator function were apparently normal. Close examination of the relative movement of the eyelids revealed evidence of superior rectus to levator synkinesis occurring during upgaze. In three cases the synkinesis was recognized only after failed ptosis surgery. Once recognized, two of these cases underwent further surgery with an excellent result. Three other patients all had successful surgery. CONCLUSIONS: Superior rectus to levator synkinesis may be easily overlooked if eyelid elevation in upgaze is ascribed to normal levator function rather than a synkinetic movement. We draw attention to the importance of identifying this relatively common condition to plan appropriate ptosis surgery. The lack of levator muscle tone in the primary position of gaze means that an augmented resection of the levator muscle should be performed.- - - - - - - - - - ranking = 0.375keywords = muscle (Clic here for more details about this article) |
9/34. Unilateral congenital oculomotor nerve palsy, optic nerve hypoplasia and pituitary malformation: a preliminary report.A newborn male presented with complete external third nerve palsy of his right eye immediately at birth. Pediatric examination and MRI of the skull revealed no abnormalities. At the age of six weeks, strabismus surgery was performed to facilitate amblyopia treatment. The muscles appeared small and fibrotic. At the age of ten weeks, a brow suspension of the upper lid and a second strabismus surgery were performed. The amblyopia treatment and patching, applied for half of the waking hours over a period of six weeks, were unsuccessful. At the age of six months, a relative pallor of the right optic nerve head became evident. At the age of three years, at a new examination because of growth deficiency, a second MRI revealed defects involving the pituitary region. We concluded that extraocular muscle abnormality or oculomotor nerve palsy was present together with optic nerve dysplasia and pituitary gland malformation.- - - - - - - - - - ranking = 0.25keywords = muscle (Clic here for more details about this article) |
10/34. Mild head injury with isolated third nerve palsy.Traumatic isolated cranial nerve palsies are uncommon and when they do occur, they are usually associated with severe head trauma. Cranial nerve palsy associated with mild head injury is rare. A case is reported of complete left third nerve palsy associated with mild head injury. The rate of recovery for complete third nerve palsy is slow and prolonged. The ptosis recovered in 10 months; the divergent squint required botulinum toxin to the lateral rectus muscle followed by surgery.- - - - - - - - - - ranking = 0.125keywords = muscle (Clic here for more details about this article) |
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