1/15. 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 = 1keywords = nerve (Clic here for more details about this article) |
2/15. Marcus Gunn jaw winking with trigemino-abducens synkinesis.Congenital ocular aberrant innervation syndromes are a complex group of disorders involving abnormal miswiring of the extraocular muscles. This case report describes a child with both a right Marcus Gunn jaw winking phenomenon and a right trigemino-abducens synkinesis, which has not previously been reported in the literature. Clinically, this child presented with an intermittent elevation of the right eyelid and/or an intermittent right exotropia when opening her mouth while sucking or chewing. This case suggests the primary abnormality in this patient may be abnormal development of the trigeminal nerve resulting in the eyelid abnormalities and strabismus.- - - - - - - - - - ranking = 0.16666666666667keywords = nerve (Clic here for more details about this article) |
3/15. Accessory lateral rectus muscle in a patient with congenital third-nerve palsy.PURPOSE: To report a case of accessory lateral rectus muscle in a patient with congenital third-nerve palsy. DESIGN: Observational case report. methods: An 18-year-old boy with left exodeviation, ptosis, pupil dilation, and limited adduction, supraduction, and infraduction of his left eye. Left lateral rectus muscle recession and medial rectus muscle resection were done. An orbital computed tomographic (CT) scan was obtained. RESULT: Intraoperatively, an accessory muscle was found under the lateral rectus muscle. Postoperatively, the orbital CT scan showed accessory lateral rectus muscle located in the medial side of the lateral rectus muscle. CONCLUSION: Accessory lateral rectus muscle was demonstrated in a patient with congenital third-nerve palsy using lateral rectus muscle surgery and an orbital CT scan.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/15. A new surgical technique for ocular fixation in congenital third nerve palsy.PURPOSE: To present a new technique of ocular fixation to restore and maintain the ocular alignment in primary position for patients with total third nerve paralysis. METHOD: We fixated the globe (medial rectus muscle insertion) to the medial palpebral ligament insertion at the anterior lacrimal crest by using nonabsorbable 5-0 polyester sutures in a prospective study of 5 patients (5 eyes) with congenital total third nerve paralysis. A large recession of the lateral rectus muscle (12 to 16 mm) was also performed in four patients. RESULTS: Four patients achieved satisfactory ocular alignment and one patient had residual exotropia. After an initial exotropic shift, no significant change in ocular alignment was observed during the follow-up period of 6 to 9 months. Mild fullness and congestion over the medial rectus muscle area was observed in the immediate postoperative period in all the patients, which resolved in about two months time. CONCLUSION: This technique of ocular fixation is easy, safe, and effective for the management of exotropia secondary to total third nerve paralysis.- - - - - - - - - - ranking = 1.1666666666667keywords = nerve (Clic here for more details about this article) |
5/15. An adjustable medial orbital wall suture for third nerve palsy.A 16-year-old girl presented with a large-angle exotropia due to congenital third nerve palsy. She had undergone recession/resection surgery as a child. A nasal transposition of the superior oblique and the lateral rectus produced some improvement but the result was still cosmetically unacceptable. Subsequent surgery to permanently secure the globe to the medial orbital wall using an intraoperatively adjustable nonabsorbable traction suture produced a satisfactory outcome.- - - - - - - - - - ranking = 0.83333333333333keywords = nerve (Clic here for more details about this article) |
6/15. Incomplete oculomotor nerve palsy caused by an unruptured internal carotid-anterior choroidal artery aneurysm--case report--.A 59-year-old woman visited our institute with the chief complaint of dizziness which persisted whenever she tried to focus on objects. She had not experienced apparent double vision and had no history of intracranial bleeding. Neurological examination revealed no abnormality except for exotropia at the mid-position and at upper gaze. cerebral angiography revealed that the intracranial portion of the left internal carotid artery ran more horizontally and also identified an unruptured left internal carotid-anterior choroidal artery (IC-AChA) aneurysm of 3.0 mm diameter. The aneurysm at the origin of the AChA was confirmed during surgery. The proximal lateral wall of the aneurysm was in contact with the oculomotor nerve. This contact was released after complete obliteration of the aneurysm. The exotropia resolved 3 months later. oculomotor nerve palsy usually indicates the presence of internal carotid-posterior communicating artery (IC-PcomA) aneurysm. Since sacrifice of the AChA will result in severe neurological deficits, accurate neuroimaging information is needed prior to the operation. Conventional angiography and/or three-dimensional computed tomography angiography should be performed to ascertain whether the aneurysm is an IC-PcomA or IC-AChA aneurysm, even if some neurosurgeons insist that conventional angiography is not always needed before surgery for an unruptured aneurysm.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/15. optic nerve massaging: an extremely rare cause of self-inflicted blindness.PURPOSE: To report a patient whose self-inflicted blindness was not clinically apparent by history or external signs of trauma. DESIGN: Observational case report. methods: A 12-year-old girl with a history of social and behavioral problems was noted to have visual loss in her right eye. Examination revealed no light perception, optic nerve atrophy, partial upper lid ptosis, exotropia, and hypoesthesia of the cheek, all on her right side. RESULTS: After undergoing extensive examinations which were unrevealing for a diagnosis, the patient admitted to a recurrent maneuver, which she secretly used to relieve anxiety and stress. This maneuver consisted of inserting her index finger under the right supraorbital rim and forcibly subluxating her globe out of the orbital space. CONCLUSIONS: Self-inflicted visual loss can occur in nonpsychotic and nonviolent patients. Accurate diagnosis is important, as there is a risk of similar involvement to the fellow eye, and referral for psychiatric counseling is mandatory.- - - - - - - - - - ranking = 0.83333333333333keywords = nerve (Clic here for more details about this article) |
8/15. Synergistic divergence: saccadic velocity analysis and surgical results.The clinical findings are described in four patients with synergistic divergence (SD), an ocular motility disorder which is considered to be a variant of duane retraction syndrome (DRS). Saccadic velocity studies in three patients demonstrated preserved abducting saccades in the affected eye with equally reduced amplitudes on both attempted abduction and adduction. The preserved saccades on attempted abduction of the affected eye, coupled with electromyographic evidence that shows maintenance of normal reciprocal innervation with respect to gaze on attempted abduction as dictated by Sherrington's law, strongly suggest that the abducens nerve is not necessarily absent or severely hypoplastic in this condition. One patient showed typical DRS in the contralateral eye and had a son with bilateral DRS, attesting to a possible genetic and etiologic relationship between SD and DRS. Three patients underwent strabismus surgery. review of our surgical results and an analysis of the literature indicate that a crippling procedure to the ipsilateral lateral rectus muscle, such as extirpation, may be necessary to eliminate simultaneous abduction. Overcorrection did not occur following lateral rectus extirpation.- - - - - - - - - - ranking = 0.16666666666667keywords = nerve (Clic here for more details about this article) |
9/15. Filamentary keratopathy caused by corneal occlusion by large-angle paralytic strabismus.PURPOSE: To report a case of filamentary keratopathy in a patient with large-angle paralytic strabismus. methods: A 31-year-old man who had a traffic accident was diagnosed to have third cranial nerve palsy and a large-angle exotropia in his right eye. The patient complained of foreign body sensation in his right eye 2 months after the accident. RESULTS: Slit-lamp examination showed multiple filaments on the right cornea. debridement of the filaments and artificial tears relieved the symptoms and were used until the paralysis resolved. CONCLUSION: Large-angle paralytic strabismus with ptosis and poor elevation and depression of the eye may occlude the cornea and lead to filamentary keratopathy.- - - - - - - - - - ranking = 0.16666666666667keywords = nerve (Clic here for more details about this article) |
10/15. Medial orbital wall fractures: complications and management.Medial wall fractures are often overlooked during routine radiographic examination and rarely develop complications. We present complications associated with medial wall fracture in six cases. Complications from medial rectus muscle entrapment include restricted and painful abduction, pseudo-sixth-nerve paresis and pseudo-Duane's-retraction syndrome. Massive orbital emphysema, in one case, was responsible for temporary loss of vision prior to definitive treatment. Two patients developed severe enophthalmos secondary to the medial wall fractures. We suggest that orbital exploration is indicated for painful or limited ocular motility, significant diplopia, severe orbital emphysema, or severe enophthalmos. An inferior approach to the medial wall through the lower eyelid provides good exposure and minimal cosmetic deformity. postoperative complications included transient paresis of the medial rectus muscle, residual motility disturbance, and residual enophthalmos.- - - - - - - - - - ranking = 0.16666666666667keywords = nerve (Clic here for more details about this article) |
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