1/7. Pseudo-entrapment of extraocular muscles in patients with orbital fractures.diplopia is a prominent finding in patients who have suffered orbital fractures. If the patient's double vision or ocular motility restriction was caused by soft tissue entrapment into the fracture site, surgery is frequently performed in order to release this entrapment and restore normal eye movement. However, the presence of diplopia should not necessarily be an indication for surgery. Brief case reports are hereby presented to illustrate that the symptoms of diplopia and motility restriction are not always attributable to the presence of orbital fractures that require surgical repair. The purpose of this article is to describe other causes of abnormal ocular motility that are associated with orbital trauma but which are not caused by soft tissue entrapment.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/7. Posttraumatic abducens to oculomotor nerve misdirection.INTRODUCTION: Paradoxical patterns of extraocular muscle, eyelid, or pupillary movements can occur following injury between divisions of the oculomotor nerve, trigeminal and abducens nerves, and trigeminal and oculomotor nerves. We report three cases of unusual ocular motility and eyelid movements that are a result of aberrant connections between the abducens and oculomotor nerves. methods: Three patients with unusual eye movement abnormalities after trauma were studied. A complete ophthalmic examination plus neuroradiologic evaluation were performed. RESULTS: Each patient manifested an aberrant connection between the 6th and 3rd cranial nerves resulting in third nerve function during sixth nerve stimulation. Two patients demonstrated complete third nerve palsies except for adduction on attempted abduction. The third showed improved bilateral ptosis on abduction. CONCLUSIONS: The neuroanatomical abnormalities involve intraorbital structures in one patient and central nervous system pathways in the others. Explanations such as retrograde regeneration, ephaptic transmission, or denervation supersensitivity do not appear to explain these unusual eye movements. The most likely mechanism involves some form of peripheral neuronal misdirection. These rare sixth to third nerve misdirection cases add support to the "neuronal misdirection hypothesis" of aberrant eye movements after trauma.- - - - - - - - - - ranking = 0.25keywords = muscle (Clic here for more details about this article) |
3/7. Abducens paralysis repaired with muscle transposition and intraoperative botulinum toxin.Surgical management of abducens paralysis has been modified frequently since the turn of the century in a continuing effort to produce not only orthotropia in the primary position but good or excellent abduction. We report a bilateral case repaired surgically by a single, whole-muscle, superior rectus transposition. Secondary medial rectus contracture, a common problem, is usually managed by surgical weakening procedures which it is difficult, if not impossible, to grade. We attempted to avoid the problem by weakening the antagonist medial rectus by intraoperative injection of botulinum toxin which might allow a self-adjusting mechanism. Using this approach, fusion in down-gaze without correction and in the primary position with a small amount of vertical and horizontal prism correction was achieved. Good to excellent abduction was restored.- - - - - - - - - - ranking = 1.25keywords = muscle (Clic here for more details about this article) |
4/7. Unusual complications of temporal bone fractures.Eighty-two temporal bone fractures were diagnosed in 75 patients with high-resolution computed tomographic scanning. Excluding six gunshot injuries, 55 (72%) of the fractures were oblique, 11 (15%) were longitudinal, and ten (13%) were transverse. Facial paresis or paralysis occurred in 45 patients (60%), hemotympanum occurred in 67 (89%), and cerebrospinal fluid otorrhea occurred in 19 (25%). Among 66 patients in whom audiometry was performed, 20 (30%) had conductive hearing loss, nine (14%) had sensorineural loss, and 36 (55%) had mixed hearing loss. Vestibular symptoms were present in 23 patients (30%). Other unusual complications of temporal bone fractures were observed: bilateral abducens paralysis, three patients (4%); unilateral abducens paralysis, two (2.67%); trigeminal paralysis, one (1.33%); and aseptic sigmoid sinus thrombosis, one (1.33%).- - - - - - - - - - ranking = 121.0678509189keywords = paresis (Clic here for more details about this article) |
5/7. Trigemino-abducens synkinesis: an unusual case of aberrant regeneration.An unusual case of major head trauma is described involving injury to the right third, fifth, sixth and seventh cranial nerves in a basal skull fracture in a young woman. Two years later there persisted a total voluntary abducens nerve palsy, right facial hemianaesthesia and right temporalis and masseter palsy. However, involuntary abduction of the involved eye occurred on eating or chewing. electromyography of the lateral rectus muscle documented aberrant reinnervation to support the clinical findings. Extraocular muscle surgery improved the compensatory head posture and minimized the chewing-induced abduction. The mechanisms for acquired synkinesis and the anatomy of the involved nerves are reviewed. It is postulated that regenerating motor fibres of the trigeminal nerve were misdirected along proprioceptive channels to the lateral rectus in the case reported here.- - - - - - - - - - ranking = 0.5keywords = muscle (Clic here for more details about this article) |
6/7. Traumatic abducens nerve paresis in a child.Trauma is a frequent cause for abducens (sixth) nerve paresis in a child, usually attributed to injury along the nerve's course. An unusual focal lesion of the sixth nerve nucleus is described.- - - - - - - - - - ranking = 605.3392545945keywords = paresis (Clic here for more details about this article) |
7/7. Anterior segment ischemia after the Jensen procedure in a 10-year-old patient.PURPOSE/methods: We recently encountered anterior segment ischemia in a young healthy girl with traumatic abducens nerve palsy after the Jensen procedure and ipsilateral recession of the medial rectus muscle. The patient was treated with topical dexamethasone and homatropine 2% and oral prednisone. RESULTS/CONCLUSION: The patient's condition improved, and six weeks postoperatively, visual acuity was 20/20. As this complication of anterior segment ischemia is potentially serious and unpredictable, we think that an alternative surgical approach should be used when treating patients with muscle palsies.- - - - - - - - - - ranking = 0.5keywords = muscle (Clic here for more details about this article) |