Diagnostic et traitement chirurgical de la parésie bilaterale de l'oblique supérieur [Diagnosis and surgical treatment of bilateral paralysis of the superior oblique muscle]
Details
Serval ID
serval:BIB_FF3E71B42221
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Diagnostic et traitement chirurgical de la parésie bilaterale de l'oblique supérieur [Diagnosis and surgical treatment of bilateral paralysis of the superior oblique muscle]
Journal
Klinische Monatsblatter fur Augenheilkunde
ISSN
0023-2165 (Print)
ISSN-L
0023-2165
Publication state
Published
Issued date
05/1995
Peer-reviewed
Oui
Volume
206
Number
5
Pages
359-364
Language
french
Notes
Publication types: English Abstract ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
Typically, bilateral superior oblique palsies manifest with small vertical deviation in primary position, reversing in lateral gaze, with a positive headtilt test on both sides, a V pattern, and a chin-down head position. In primary position, excyclotropia often exceeds 10 degrees and markedly increases in inferior gaze.
Retrospective study of 21 patients with bilateral SO palsy who underwent operations including various surgical techniques such as SO tucking, inferior oblique recessions and inferior rectus weakering procedures (recession, posterior fixation). Preoperative symptoms of this group of patients was compared to those of 60 patients with unilateral SO palsy.
No significant difference was found between cases operated with complete SO tucking and cases operated with specific surgery on the anterior part of the tendon when pre- and postoperative excyclotropia was compared. Severe excyclotropia in primary gaze, markedly increasing in downgaze, was found to be statistically significantly associated with bilateral lesions (p = 0.001).
Bilateral SO palsy, even when highly asymetrical, can be surely diagnosed by carefully measuring excyclotorsion in both primary and downgaze by using dissociating devices. To avoid iatrogenic postoperative Brown syndrome it is recommended to adjust the amount of bilateral superior oblique tucking peroperatively, according to the degree of tendon extensibility. In cases of very severe excyclotorsion such a procedure can be completed by mild bilateral simultaneous inferior oblique recessions.
Retrospective study of 21 patients with bilateral SO palsy who underwent operations including various surgical techniques such as SO tucking, inferior oblique recessions and inferior rectus weakering procedures (recession, posterior fixation). Preoperative symptoms of this group of patients was compared to those of 60 patients with unilateral SO palsy.
No significant difference was found between cases operated with complete SO tucking and cases operated with specific surgery on the anterior part of the tendon when pre- and postoperative excyclotropia was compared. Severe excyclotropia in primary gaze, markedly increasing in downgaze, was found to be statistically significantly associated with bilateral lesions (p = 0.001).
Bilateral SO palsy, even when highly asymetrical, can be surely diagnosed by carefully measuring excyclotorsion in both primary and downgaze by using dissociating devices. To avoid iatrogenic postoperative Brown syndrome it is recommended to adjust the amount of bilateral superior oblique tucking peroperatively, according to the degree of tendon extensibility. In cases of very severe excyclotorsion such a procedure can be completed by mild bilateral simultaneous inferior oblique recessions.
Keywords
Adolescent, Adult, Aged, Aged, 80 and over, Child, Duane Retraction Syndrome/diagnosis, Duane Retraction Syndrome/physiopathology, Duane Retraction Syndrome/surgery, Exotropia/physiopathology, Exotropia/surgery, Female, Follow-Up Studies, Functional Laterality/physiology, Humans, Male, Middle Aged, Oculomotor Muscles/physiopathology, Oculomotor Muscles/surgery, Postoperative Complications/physiopathology, Postoperative Complications/prevention & control, Retrospective Studies
Pubmed
Web of science
Create date
06/10/2022 11:47
Last modification date
10/02/2024 7:15