Orbital Nerves

2012 ◽  
Author(s):  
David Jordan ◽  
Louise Mawn ◽  
Richard L. Anderson
Keyword(s):  
Lacrimal Gland ◽  
Cranial Nerve ◽  
Motor Nerve ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
Sympathetic Nerves ◽  
Lower Eyelid ◽  
Infraorbital Nerve ◽  
Ciliary Ganglion ◽  
Orbital Surgery

The orbit contains a vast array of motor, sensory, sympathetic, and parasympathetic nerve fibers. Some of these fibers can be seen during eyelid or orbital surgery and are often landmarks of one’s location within the orbit. It is important to know the various nerve pathways, appreciate that there might be some individual variation, and preserve these pathways during orbital surgery. The discussion of nerves begins with their superficial brainstem origin, proceeds to their intracranial course, and ends with their intraorbital course and eventual termination. The following nerves enter the orbit: 1. Optic nerve (cranial nerve II). 2. Oculomotor nerve (cranial nerve III). This motor nerve gives fibers to the levator, inferior oblique, and three of the four rectus muscles. It carries parasympathetic fibers destined for the ciliary ganglion. These fibers will eventually synapse in the ciliary ganglion and then travel to the iris sphincter muscles (sphincter pupillae). Sympathetic fibers have also been recently identified in this nerve. 3. Trochlear nerve (cranial nerve IV). This motor nerve distributes fibers to the superior oblique muscle. Sympathetic fibers have recently been identified within this nerve. 4. Trigeminal nerve (cranial nerve V). a. Ophthalmic division (V 1 ) . This sensory division gives fibers to the eyeball (iris, ciliary body, cornea), lacrimal gland, conjunctiva, and eyelids, as well as to the forehead. It also carries sympathetic nerves. b. Maxillary division (V 2 ) . As it enters the orbit, the maxillary division is known as the infraorbital nerve and lies beneath the periorbita. It gives off the zygomatic nerve, which is an important branch carrying parasympathetic and sympathetic fibers to the lacrimal gland. Within the infraorbital canal, alveolar nerves arise and provide sensation to the incisor and canine teeth. The infraorbital nerve provides sensation to the lower eyelid, nose, cheek area, and upper lip. 5. Abducens nerve (cranial nerve VI). This motor nerve goes to the lateral rectus muscle. Sympathetic fibers have recently been identified within this nerve.

The abducens nerve

1974 ◽  
Vol 41 (5) ◽  
pp. 561-566 ◽  
Author(s):  
Hilel Nathan ◽  
Georges Ouaknine ◽  
Isaac Z. Kosary
Keyword(s):  
Cavernous Sinus ◽  
Subarachnoid Space ◽  
Cranial Nerve ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
The Other ◽  
Sixth Cranial Nerve ◽  
Content Type ◽  
Lateral Rectus Muscle ◽  
Fine Print

✓ The authors describe the origins and course of the sixth cranial nerve in 62 cadaver or autopsy cases and describe three patterns. In Pattern 1 the nerve originates and runs all its way as a single trunk. In Pattern 2 it originates as a single trunk, but splits into two branches in the subarachnoid space, while in Pattern 3 it originates as two separate trunks. In both Patterns 2 and 3 the trunks perforate the dura mater independently and enter the cavernous sinus by passing one above and the other below the petrosphenoidal ligament. In the sinus the two trunks fuse into a single trunk which then continues to the lateral rectus muscle. The practical neurological importance of these variations is discussed.

Orbital Connective Tissue

2012 ◽  
Author(s):  
David Jordan ◽  
Louise Mawn ◽  
Richard L. Anderson
Keyword(s):  
Connective Tissue ◽  
Rectus Muscle ◽  
Lower Eyelid ◽  
Extraocular Muscles ◽  
Contributing Factors ◽  
Inferior Rectus ◽  
Orbital Surgery ◽  
Tenon’S Capsule ◽  
Tenon's Capsule ◽  
Superior Sulcus

A diffuse connective tissue framework exists within the orbital space that supports various orbital structures, maximizing their function and maintaining anatomic relationships between them. Some connective tissue septa are aligned with directions of force and serve to resist displacement of the extraocular muscles during contraction. Other fascial septa suspend and support delicate orbital vascular and neural elements. All orbital structures, including the periorbita, globe, optic nerve, and extraocular muscles, are involved in the organization and suspension of these extensive connective tissue septal systems. This intricate framework has several important components that are oft en difficult to see clinically and during orbital surgery but which must always be kept in mind as playing a role in the clinical presentation of a particular orbital problem. For example, a blowout fracture of the orbital floor with restricted motility in upgaze might be due to entrapment of the inferior rectus muscle within the fracture, but more commonly it is due to entrapment of the connective tissue framework + / − fat in the inferior orbit. Enophthalmos, a deep superior sulcus, ptosis, and lower eyelid malposition are commonly seen following enucleation surgery. Loss of volume (of the globe) certainly plays a role, but other contributing factors, including a disruption of the connective tissue framework (which helps support the globe), might be playing a role. Trauma to Tenon’s capsule, Whitnall’s ligament, Lockwood’s ligament, or check ligaments associated with the recti muscles, as well as the intermuscular fascial connections, might also contribute to the postenucleation socket abnormalities mentioned above, as their disruption allows the shifting of orbital tissues to occur. Evisceration surgery is associated with less disruption to the connective tissue framework, and as a result features of postenucleation socket syndrome other than loss of volume are not as common. Historically, four major connective tissue components in the orbit have been described: 1. the bulbar fascia, or Tenon’s capsule, which surrounds the globe; 2. the fascial sheaths of the extraocular muscles; 3. the intermuscular septum (the common muscle sheath connecting the four rectus muscles); and 4. the medial and lateral check ligaments.

The Abducens Nerve: Microanatomic and Endoscopic Study

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-7-ONS-14 ◽  
Author(s):  
Giorgio Iaconetta ◽  
Mario Fusco ◽  
Luigi M. Cavallo ◽  
Paolo Cappabianca ◽  
Madjid Samii ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
Nerve Injuries ◽  
Endoscopic Endonasal ◽  
Lateral Rectus Muscle ◽  
Endoscopic Study ◽  
Anatomic Dissection ◽  
Neurovascular Structures

Abstract Objective: Only a few anatomic studies concerning the intra- or extracranial course of the abducens nerve (Cranial Nerve VI) have been reported. This is likely because the nerve passes through anatomically intricate areas, making its neurovascular relationships complex. Here we provide an anatomically and surgically oriented classification of the abducens nerve, analyze the microanatomy of the nerve and the surrounding connective and/or neurovascular structures, and provide measurements and anatomic topography. Patients and Methods: A microsurgical anatomic dissection of 55 cadaveric human heads was performed using different skull base approaches to explore the entire course of the VIth cranial nerve, from its origin at the pontomedullary sulcus to the lateral rectus muscle. We then approached the same areas via an endoscopic endonasal transsphenoidal route, analyzed the neurovascular relationships from an anteromedial perspective, and made comparisons with the microsurgical views. Results: The abducens nerve is divided into five segments, of which three are intracranial (cisternal, gulfar, and cavernous) and two are orbital (fissural and intraconal). Using two opposing surgical routes (microsurgical transcranial and endoscopic endonasal approaches) allows us to clearly reveal the spatial relationships of the abducens nerve with other neurovascular structures on the different nerve segments. Conclusion: The classification of five segments for the abducens nerve seems anatomically valid and is surgically oriented with respect to both the microscopic and endonasal endoscopic approaches. It would be useful to explain, segment by segment, the pathogenic mechanism(s) for nerve injuries that are evidenced by lesions that exist along the entire intra- and extracranial course.

scholarly journals Benign abducens nerve palsy: diagnosis by exclusion

2019 ◽  
Vol 6 (3) ◽  
pp. 1380
Author(s):  
Praveen U. ◽  
Sushma Save ◽  
Sanjay Singh
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Cranial Nerves ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
Immunological Reaction ◽  
Post Vaccination ◽  
Lateral Rectus Muscle ◽  
Diagnosis By Exclusion ◽  
History Of

Of all the cranial nerves, the abducens nerve has the longest intracranial course hence is most common cranial nerve to be affected secondary to any potentially devastating intracranial cause. It can indicate significant underlying pathology. Abducens or sixth cranial nerve innervates lateral rectus muscle and pathology of this nerve results in abduction deficiency of ipsilateral eye. Most of the time it will be unilateral but bilateral involvement is also well known. It can recurrent without any underlying identifiable pathology. The 6th nerve palsy is considered as benign after ruling out all possible causes. Benign causes account for just 9 to 14% of all 6th nerve palsies in children. Most of the time benign 6th nerve palsy occurs after viral infection or vaccination as an immunological reaction. In our case patient had history of pentavalent vaccination 1 month back. After thorough investigation and ruling out all possible causes it was attributed to post vaccination immunological reaction. which resolved spontaneously over 4months.

Intramuscular Distribution of the Abducens Nerve in the Lateral Rectus Muscle for the Management of Strabismus

2018 ◽  
Vol 43 (6) ◽  
pp. 689-695 ◽  
Author(s):  
Hyun Jin Shin ◽  
Shin-Hyo Lee ◽  
Kang-Jae Shin ◽  
Ki-Seok Koh ◽  
Wu-Chul Song
Keyword(s):  
Rectus Muscle ◽  
Abducens Nerve ◽  
Lateral Rectus ◽  
Lateral Rectus Muscle

The Lateral Rectus Muscle and Sixth Cranial Nerve in the Pig

Nature ◽  
1956 ◽  
Vol 178 (4537) ◽  
pp. 798-799 ◽  
Author(s):  
M. E. LAW ◽  
M. J. T. FITZGERALD
Keyword(s):  
Cranial Nerve ◽  
Rectus Muscle ◽  
Lateral Rectus ◽  
Sixth Cranial Nerve ◽  
Lateral Rectus Muscle

scholarly journals Tumors Presenting as Multiple Cranial Nerve Palsies

2017 ◽  
Vol 9 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Kishore Kumar ◽  
Rafeeq Ahmed ◽  
Bharat Bajantri ◽  
Amandeep Singh ◽  
Hafsa Abbas ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Systemic Disease ◽  
Cranial Nerves ◽  
B Cell Lymphoma ◽  
Abducens Nerve ◽  
Cranial Nerve Involvement ◽  
Nerve Involvement ◽  
Cranial Nerve Palsies ◽  
Multiple Cranial Nerve

Cranial nerve palsy could be one of the presenting features of underlying benign or malignant tumors of the head and neck. The tumor can involve the cranial nerves by local compression, direct infiltration or by paraneoplastic process. Cranial nerve involvement depends on the anatomical course of the cranial nerve and the site of the tumor. Patients may present with single or multiple cranial nerve palsies. Multiple cranial nerve involvement could be sequential or discrete, unilateral or bilateral, painless or painful. The presentation could be acute, subacute or recurrent. Anatomic localization is the first step in the evaluation of these patients. The lesion could be in the brain stem, meninges, base of skull, extracranial or systemic disease itself. We present 3 cases of underlying neoplasms presenting as cranial nerve palsies: a case of glomus tumor presenting as cochlear, glossopharyngeal, vagus and hypoglossal nerve palsies, clivus tumor presenting as abducens nerve palsy, and diffuse large B-cell lymphoma presenting as oculomotor, trochlear, trigeminal and abducens nerve palsies due to paraneoplastic involvement. History and physical examination, imaging, autoantibodies and biopsy if feasible are useful for the diagnosis. Management outcomes depend on the treatment of the underlying tumor.

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