Two cases of acquired bilateral trochlea nerve palsy treated by simultaneous inferior rectus muscle nasal transposition and inferior oblique muscle myectomy

This paper presents a comparative study of the effectiveness of myectomy and anterior transposition in the treatment of inferior oblique muscle overaction. We operated 160 patients with overaction of the inferior oblique muscle. Eighty patients (148 eyes) were operated by myectomy at the insertion and 80 patients (151 eyes) by anterior transposition of the insertion of the inferior oblique near the temporal side of the insertion of the inferior rectus muscle. Comparison of the two methods, using the chi-squared test, showed that: 1) both surgical procedures were equally effective (χ2=0.26) for correcting overaction of the inferior oblique muscle and V-phenomenon; 2) weakening of the inferior oblique muscle of both eyes was almost always required (in 115 out of 116 cases) in cases with V-phenomenon and often (24 out of 44 cases) in cases of congenital paresis of the superior oblique muscle. We conclude that both procedures are equally effective and equally easy to perform.

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Inferior rectus pulled-in-two syndrome: Surgical results after anterior and nasal transposition of the inferior oblique muscle

European Journal of Ophthalmology ◽

10.1177/1120672120957585 ◽

2020 ◽

pp. 112067212095758

Author(s):

Massimiliano Serafino ◽

Andrea Lembo ◽

Matteo Scaramuzzi ◽

Andrea Dellavalle ◽

Paolo Nucci

Keyword(s):

Muscle Weakness ◽

Extraocular Muscle ◽

Rectus Muscle ◽

Strabismus Surgery ◽

Oblique Muscle ◽

Surgical Results ◽

Inferior Rectus ◽

Inferior Oblique Muscle ◽

Intraoperative Complication ◽

Inferior Rectus Muscle

Pulled-in-two syndrome (PITS) is a serious intraoperative complication of strabismus surgery in which an extraocular muscle manipulated during the procedure is ruptured and potentially lost. Usually, there is a systemic or local condition that determines muscle weakness when put under tension. If the proximal portion of the broken muscle can be found, it can be reattached to the ocular globe or remaining muscle. If this is not possible, there are multiple varying approaches. We present three cases of PITS of the inferior rectus muscle, treated with good results with anterior and nasal transposition of the inferior oblique muscle. We propose this surgery as another potential technique if the muscle can not be retrieved.

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Anterior transposition of the inferior oblique muscle as the initial treatment of a snapped inferior rectus muscle

Journal of American Association for Pediatric Ophthalmology and Strabismus ◽

10.1067/mpa.2001.111014 ◽

2001 ◽

Vol 5 (1) ◽

pp. 52-54 ◽

Cited By ~ 11

Author(s):

Blanca I. Aguirre-Aquino ◽

Christopher D. Riemann ◽

Hilel Lewis ◽

Elias I. Traboulsi

Keyword(s):

Initial Treatment ◽

Rectus Muscle ◽

Oblique Muscle ◽

Inferior Rectus ◽

Inferior Oblique Muscle ◽

Anterior Transposition ◽

Inferior Rectus Muscle

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Compartmental Endoscopic Surgical Anatomy of the Inferior Intraconal Orbital Space

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1604405 ◽

2017 ◽

Vol 79 (02) ◽

pp. 189-192 ◽

Cited By ~ 7

Author(s):

Alice Maxfield ◽

Christopher Brook ◽

Marcel Miyake ◽

Benjamin Bleier

Keyword(s):

Rectus Muscle ◽

Anatomical Study ◽

Surgical Anatomy ◽

Oblique Muscle ◽

Inferior Rectus ◽

Inferior Oblique Muscle ◽

Safe Technique ◽

Orbital Space ◽

Neurovascular Structures ◽

Inferior Rectus Muscle

Objectives This study aims to define the endoscopic anatomy of inferior intraconal space, in terms of its neurovascular structures and relationship to fixed anatomic landmarks. Design A cadaveric anatomical study was conducted. Setting This study was conducted at an academic cranial base center. Participants Cadaveric subjects have been investigated. Main Outcome Measures After dissection of the inferior intraconal space, the number and position of ophthalmic artery (OA) and oculomotor nerve (OMN) branches to the inferior rectus muscle (IRM) were quantified relative to the fixed landmark of the posterior maxillary wall. The point where the OMN branch to the inferior oblique muscle (IOM) crossed the lateral IRM margin was quantified. Results A total of 18 OA branches were identified with a mean ± standard deviation of 2.6 ± 0.53 branches. The mean distance of the OA branch insertion from the posterior maxillary wall was 7.11 ± 5.65 mm. The average number of OMN branches to the IRM was 1.63 ± 0.74 with a mean insertion distance of 1.88 ± 1.89 mm. The OMN branch to the IOM crossed the lateral IRM margin 5.38 ± 5.42 mm from the posterior maxillary wall. Conclusions This cadaveric study quantifies the variability of two critical neurovascular structures salient to endoscopic approaches to the inferior intraconal space, the OMN, and OA contributions to the IRM. Knowledge of the interrelationship between these structures is essential in safe technique for dissection.

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Comparison of the Superior and Inferior Rectus Muscles in Humans: An Anatomical Study with Notes on Morphology, Anatomical Variations, and Intramuscular Innervation Patterns

BioMed Research International ◽

10.1155/2020/9037693 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Robert Haładaj ◽

Michał Polguj ◽

R. Shane Tubbs

Keyword(s):

General Pattern ◽

Rectus Muscle ◽

Anatomical Variations ◽

Oculomotor Nerve ◽

Oblique Muscle ◽

Inferior Rectus ◽

Inferior Oblique Muscle ◽

Superior Rectus ◽

Superior Rectus Muscle ◽

Inferior Rectus Muscle

A comparison of the superior and inferior rectus muscles was performed to determine whether they have similar structures and innervation attributable to their participation in the same type of, although antagonistic, eye movements. The study was conducted on 70 cadaveric hemiheads, and the anatomical variations in the superior and inferior rectus muscles were assessed. Sihler’s whole mount nerve staining technique was used on 20 isolated superior and 20 isolated inferior rectus muscle specimens to visualize the intramuscular distribution of the oculomotor nerve subbranches. In two cases (~2.8%), variant muscular slips were found that connected the superior and inferior rectus muscles. In 80% of cases, muscular branches arising directly from the inferior branch of the oculomotor nerve innervated the inferior rectus muscle, while in 20% of cases, the nerve to the inferior oblique muscle pierced the inferior rectus muscle and provided its innervation. In 15 of 70 specimens (21.4%), a branch to the levator palpebrae superioris muscle pierced the superior rectus muscle. The distance between the specific rectus muscle’s insertion and the anterior-most terminations of the nerves’ subbranches with reference to the muscle’s total length ranged from 26.9% to 47.2% for the inferior rectus and from 34.8% to 46.6% for the superior rectus, respectively. The superior rectus muscle is slightly longer and its insertion is farther from the limbus of the cornea than is the inferior rectus muscle. Both muscles share a common general pattern of intramuscular nerve subbranches’ arborization, with characteristic Y-shaped ramifications that form the terminal nerve plexus located near half of the muscles’ length. Unexpected anatomical variations of the extraocular muscles may be relevant during orbital imaging or surgical procedures.

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