[Traumatic III nerve palsy]. / Therapiekonzept für traumatische Okulomotoriusparesen.

Ptosis, anisocoria, loss of accommodation, incomitant exotropia, vertical and torsional disorders are the obstacles for binocularity after a traumatic III nerve palsy when a usable fusion field of vision with a more or less level head is to be acheived. To accept monocular vision may be the best choice in many cases. Therapeutic efforts to restore binocularity must deal with all aspects of the palsy. Strongly contraindicated are uncritical ptosis operations or simple repositioning interventions on the fellow eye to merely reduce the angle. Those who have a good knowledge of the entire spectrum of ocular muscle surgery, have experienced contact lens specialists at hand, and are proficient in all procedures of refractive lens surgery may, after comprehensive patient counselling, attempt to treat these patients and can in isolated cases achieve functionally useful results.

[Free mucosa transplant in the correction of extreme deviations of exotropia]. / Freie Schleimhautplastik bei der Korrektur extremer divergenter Schielwinkel.

BACKGROUND: The majority of cases of exotropia with extreme deviations (30-45 degrees or 60-90 prism dioptres) are secondary forms of strabismus, either consecutive, following monolateral combined recession/resection procedures in childhood, extreme anisometropia or following trauma. For the surgical treatment the deviation is often too great to be corrected completely by conventional repositioning of the medial and lateral rectus muscle of the affected eye and patients justifiably refuse an operation even on the main eye because the indications are mostly more aesthetic than functional. METHODS: The paper presents a technique of a free mucosa transplant. The effect can be strengthened and made more secure following repositioning of the muscle. RESULTS: With this method even extreme deviations (up to 45 degrees corresponding to 90 prism dioptres) could be successfully and permanently corrected by surgery on the deviated one eye only. CONCLUSIONS: This method provides a new option for patients who are often incorrectly told that their deviation cannot be corrected by monolateral surgery.

Intraoperative brachial plexus injuries during reconstruction of the burned axilla.

Since opening of the Shriners Burns Institute, Cincinnati Unit, 501 operations for release of burn scar-related contractures of the axilla have been carried out with skin grafting. Six of these cases, 1.2%, resulted in intraoperative stretch injuries to the brachial plexus. In two cases, isolated axillary nerve involvement was encountered. In four cases, additional diffuse injury to the brachial plexus was present. Intraoperative motion and postoperative splinting in a position of abduction were believed to be possible etiological agents. Prompt removal of the splint and institution of physical therapy were carried out. In all cases, there was full return of neurologic function. Indications for surgery were preoperative limitation of abduction at the shoulder due to scar in five cases; one operation was performed for cosmetically disfiguring webbing. Final range of motion, 1 year postoperatively, was normal in all cases. Time to full recovery varied from 2 to 9 months. The importance of preventing the problem by keeping intraoperative motion to a minimum and checking neurologic function promptly in the postoperative period is stressed.