Yuji Nemoto

Results of Surgery for Paralytic Exotropia due to Oculomotor Palsy

In 138 cases of paralytic exotropia due to oculomotor palsy, transposition of the superior oblique muscle and resection of the medial rectus muscle were carried out. Surgery was performed with or without recession of the lateral rectus muscle. The long-term prognosis for 4 years or more was observed in 35 cases. We found that the same results could be obtained by selecting transposition of the superior oblique muscle in cases of complete palsy and resection of the medical rectus muscle in cases of incomplete palsy. There was no benefit in combining resection of the medial rectus muscle when performing the transposition of the superior oblique muscle. Regardless of which method was used, a combination with recession of the lateral rectus muscle greatly improved the effectiveness of the procedure.

Anatomical reasons for problems after neurectomy for blepharospasm: a study in cadavers.

The purpose of this study is to clarify the mechanisms of the problems that develop after neurectomy for blepharospasm. The left facial nerves in 10 Japanese cadavers were dissected under a surgical microscope. The temporal, zygomatic, and buccal branches innervated to the orbicularis oculi muscle. These three groups formed a well-communicating plexus posterior to the orbicularis. The most inferior buccal branch curved in the deep layer in the lower part of the cheek. In the cheek, both the buccal and the temporal branches had ramifications of other facial muscles. The information given in previous anatomical textbooks did not specifically define the denervation of the orbicularis. When neurectomy was done in the past, the inferior buccal branch may have been kept intact, or other facial muscles as well as the orbicularis may have been denervated which caused the blepharospasm to recur and complications to develop after neurectomy.

Skew Transposition of Vertical Rectus Muscles for Excyclovertical Deviation

PURPOSE The authors established a surgical treatment for excyclovertical strabismus in which either the inferior rectus muscle or the superior rectus muscle was transposed diagonally. The effects and the safety of the procedure, called skew transposition, were studied. METHODS Eighteen operations using local anesthesia with eye drops were performed on 17 cases, including 10 with superior oblique palsy. Diplopia was checked during the operation with the cooperation of each patient. Both the clinical findings and eye deviation were examined during observation periods. RESULTS After the first operation, the diplopia in the primary position had disappeared in 10 cases and had improved in the other 7. The average effect of all operations on excyclodeviation was a correction of 6.2 degrees in the primary position. In the 7 cases of superior oblique palsy that received nasal recession of the inferior rectus muscle, the average correction of excyclodeviation was 6.4 degrees, and vertical deviation improved 1.8 degrees per 1 mm of recession. In no case did the diplopia worsen, nor were there any complications. CONCLUSIONS This safe procedure facilitates the simultaneous improvement of both excyclo- and vertical deviations. It may become the treatment of choice for excyclovertical strabismus.

SUPERSELECTIVE NEURECTOMY WITH PERIORBITAL PRIMARY RECONSTRUCTION FOR BLEPHAROSPASM: Case report

A 66-year old man with blepharospasm and ptosis of the brow was treated with a combined procedure in which the branches of the facial nerve were excised at the margin of the orbicularis, and the periorbital area was reconstructed simultaneously. The condition improved after the treatment with no occurrence of either oral complications or facial anaesthesia.A 66-year old man with blepharospasm and ptosis of the brow was treated with a combined procedure in which the branches of the facial nerve were excised at the margin of the orbicularis, and the periorbital area was reconstructed simultaneously. The condition improved after the treatment with no occurrence of either oral complications or facial anaesthesia.

A clear cell type meningioma in the upper eyelid ascertained by immunohistochemical examination

BACKGROUND We encountered a rare case of clear cell meningioma in the upper eyelid. CASE A 66-year-old man presented with a slow by progressive, well-defined, soft globelar tumor in the left upper eyelid. The tumor showed homogeneous isodensity and was contrasty in a computed tomograph. Histologically, oval-shaped cells with clear cytoplasm had both streamed and whorl configurations, but showed neither psammomas nor calcification. Immunohistochemically, vimentin, epithelial membrane antigen, and protein S-100 were expressed by the tumor cells. CONCLUSIONS Eyelid meningioma may originate from embryonal remains of the arachnoid in the sheath around the trigeminal nerve, and may vary histologically. Immunohistochemical examination helps to define cases of uncommon subtypes of meningioma.

Advancement of the frontalis muscle for ptosis of the brow associated with essential blepharospasm

We evaluated our results of advancement of the frontalis muscle to correct brow ptosis associated with blepharospasm in five patients who had difficulty opening their eyelids as a result of ptosis even after injections of botulinum toxin. The frontalis muscle was retracted inferiorly and connected directly to the skin of the eyebrow. Postoperatively the level of the eyebrow was raised above the superior orbital rim in all cases during the observation period (4 to 15 months). Although the operation did not improve muscle spasms, it successfully shortened the duration of involuntary closure of the eyelid. The only postoperative complication was lymphoedema of the eyelids. Results of postoperative injection of botulinum toxin were satisfactory. Advancement of the frontalis muscle corrects brow ptosis without major complications, and is complementary to injection of botulinum toxin.

[Bilateral progressive supra-fixing eyes with congenital misinsertion of inferior rectus muscles--a case report].

BACKGROUND We report on a rare case with misinsertion of the inferior rectus muscles, that showed bilateral progressive supra-fixing eyes. CASE A 68-year-old woman showed bilateral progressive supra-fixing eyes with low vision that was caused by microcorneas and retionochoroidal atrophy. Passive infraduction was restricted bilaterally, but the right inferior rectus muscle was innervated normally. Magnytic resonance imaging(MRI) demonstrated nasal misposition of bilateral inferior rectus muscles. The patients eye position was improved after combined transposition of the inferior rectus muscles that were misinserted nasally to the inferior poles of the eyes and superior rectus muscle recession, without any complications. CONCLUSION A dysfunction of bilateral depressor muscles and low vision may cause this condition. Accurate diagnosis with MRI and correction of the affected muscles to the normal anatomical position produces satisfying results in such cases.