A case report of inferior oblique reattachment after Inferomedial Orbital Wall Reconstruction from Total Maxillectom

@#The detachment and reattachment of inferior oblique (IO) have been done by ophthalmologists in inferomedial orbital wall fracture repair to avoid inducing a new diplopia in patients post-operatively. However, doing them in orbital wall reconstruction in patient who underwent maxillectomy for a malignancy has not been described yet. We describe a case where a disinserted inferior oblique was reattached after titanium mesh implantation to prevent diplopia after the surgery. This is the case of a 40-year-old male diagnosed with recurrent bilateral nasomaxillary ameloblastoma who underwent total maxillectomy of the right with removal of the inferomedial orbital wall, and detachment and reattachment of inferior oblique with no resulting inferior oblique palsy and diplopia from hypotropia or incyclotorsion. This is the first report, to our knowledge, to describe reattachment of IO in its approximate insertion during reconstruction of the inferomedial orbital wall after total maxillectomy from a malignancy with no resulting diplopia.

Three methods of surgical treatment for upper eyelid retraction / 局解手术学杂志

objective To explore a reasonable treatment for upper eyelid shrinking. Methods All 15 patients with upper eyelid retrac-tion were divided in group A,group B and group C. Group A with 9 eyes received botulinum toxin type A,group B with 10 eyes were corrected by central aponeurosis disinsertion,group C with 9 eyes upper eyelid were corrected by the lengthening of the levator muscle and Müller's muscle. And the data was summarized and analyzed. Results Five cases (9 eyes) with upper eyelid shrinking obviously were improved 72 h after injecting botulinum toxin type A,but the eyelids returned to previous states 4~6 months later. The shape of postoperative eyelid was good and the eyelids structure was natural in group B,recurrence was in 2 cases. Patients in group C had satisfactory results. And there was no recurrence and complications after 3~24 months of follow-up. Conclusion The three treatments have effect on upper eyelid shrinking at quiescence phase. The method of injecting botulinum toxin type A is simple,with reliable curative effect and short duration,while it was nee-ded repeated injections. The method of central aponeurosis disinsertion is simple but difficult to quantify properly. The lengthening of the leva-tor muscle is not only simple but also with reliable effect and less complications.

Medial Rectus Dehiscence following Buckling.

Migration of silicone explants through rectus muscle insertion is a rare complication with very few cases reported. Anterior migration of a solid silicone band may occur if it is tight, placed anterior to the equator or not properly anchored to the sclera. The band slowly erodes through the tendon of one or more recti muscles allowing them to reattach spontaneously with scar tissue behind migrating element. The authors describe a rare case of anterior migration of the buckle following encirclage by a 4mm silicone band resulting in spontaneous disinsertion of medial rectus muscle where muscle disinsertion had not been performed peroperatively. This migration occurred in the absence of any predisposing factors. The muscle disinsertion was so gradual that the muscle got reinserted almost to its original insertion as a result of which there was no heterotropia .

Change of Muscle Insertion Position after Disinsertion of Extraocular Muscles

PURPOSE: This study examines the change in distance from the corneal limbus to the insertion of the rectus muscles before and after disinsertion and retraction with a pair of fixation forceps during strabismus surgery. METHODS: In 38 strabismus patients, on 30 medial rectus muscles and 38 lateral rectus muscles, before and after disinsertion and retraction with a pair of fixation forceps, the distances from the corneal limbus to the upper, middle and lower parts of the insertion of the medial and lateral rectus muscles marked with methylene blue solution were measured. RESULTS: The distances between the corneal limbus and upper, middle and lower parts of the insertion after the disinsertion were reduced on, average 0.23 mm, 0.28 mm, and 0.18 mm, for the medial rectus muscle, respectively, and 0.21 mm, 0.28 mm, and 0.15 mm, for the lateral rectus muscle, respectively (P<0.05). The percentage of cases in which the advance from the corneal limbus to the insertion was greater than 0.5 mm was 33.3% for the medial rectus muscle, and 21.1% for the lateral rectus muscle. The lateral rectus muscle was disinserted, fixed with a pair of forceps, and subsequently, the distance from the upper, middle and lower parts to the corneal limbus were reduced to 0.36 mm, 0.43 mm, and 0.30 mm, respectively (P<0.05). The percentage of cases that advanced more than 1.0 mm was 13.2 %. The changes in distance from the upper, middle, and lower parts of insertion toward the limbus after disinsertion and retraction were 0.15 mm 0.15 mm, 0.16 mm, respectively (P<0.05). CONCLUSIONS: When performing the recession of the lateral rectus muscle, disinsertion of the rectus muscle, may result in a change of the site of insertion, which in turn might influence the outcome of strabismus surgery.

Divergent Strabismus Fixus

Strabismus fixus is a rare condition in which one or both eyes are anchored, as a rule, in a position of extreme adduction or abduction. The involved eye is "fixed" in this position and cannot be moved, and the forced duction test will confirm the immobility of the eye. The condition generally is thought to be congenital and caused by fibrosis, which would explain the loss of elasticity of the rectus muscle. Divergent forms of strabismus fixus not accompanied by ptosis or generalized fibrosis of the extraocular muscle are even more unusual. The authors experienced one case of divergent strabismus fixus in a 23 year old female patient. We performed complete disinsertion of both lateral rectus muscle and recession of conjunctiva and Tenon's capsule, combined with 11 mm resection of medial rectus muscle of left eye. The result of that surgery, however, was not satisfactory. So we performed 11 mm resection of medial rectus muscle of right eye and temporary fixation of the globes with traction sutures in a position of abbuction on both eyes at 3 days after the first surgery. After 4 weeks, patient was remained 60 delta exodeviation but primary position and ocular motility were improved.