Transcaruncular rectus tendon fixation to the orbit and frontalis flap for complete third nerve palsy

• Published in: Orbit (Amsterdam) Vol. 38; no. 1; pp. 13 - 18
• Main Authors: Medel Jiménez, Ramón, Sánchez España, Juan C., Visa Nassarre, José, Ayala Barroso, Eva, Pueyo Ferrer, Alfredo, Tapia Bahamondes, Alejandra, Vasquez, Luz M.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02.01.2019
• Subjects: Adolescent; Adult; Aged; Blepharoptosis - surgery; exotropia; Female; frontalis flap; Humans; Male; Middle Aged; Oculomotor Muscles - surgery; Oculomotor Nerve Diseases - surgery; Orbit; Orbit - surgery; ptosis; Retrospective Studies; Surgical Flaps; Tendons - surgery; third nerve palsy; Vision, Binocular - physiology; Young Adult; third nerve palsy; frontalis flap; Orbit; exotropia; ptosis
• ISSN: 0167-6830; 1744-5108
• DOI: 10.1080/01676830.2018.1449224

Purpose: To describe our experience and outcomes managing complete third cranial nerve palsy. Methods: This was a retrospective analysis of the clinical records of 7 consecutive patients treated at our centre for unilateral third nerve palsy over the period 2010-2016. We describe our surgical approach using a frontalis muscle flap to correct the eyelid ptosis associated with medial fixation of the rectus muscle tendon to the orbit to correct the horizontal deviation. Results: The seven patients, four women and three men, were of mean age of 44 ± 19 years [18-75 years]. Follow up was 29 ± 31 months [5-82 months]. In the preoperative exam, exotropia in prism diopters (PD) was −70 ± −28 PD [−30 to −90 PD]. At the end of follow up, this was reduced to −11 ± −14 PD [0 to −30 PD]. Preoperative marginal reflex distance 1 (MRD1) was −4 ± 1 mm [−3 to −5 mm] and palpebral fissure height (PFH) was 0.5 ± 1 mm [0-2 mm]. Surgical undercorrection was the target in all patients due to the absent or poor Bell's phenomenon. At the end of follow up, MRD1 was 2.5 ± 0.5 mm [2-3 mm] and PFH was 7 ± 1 mm [6-8 mm]. Cosmetic and functional results were good in all patients. Conclusions: Medial fixation of the rectus muscle tendon to the orbit associated with a frontalis muscle flap is a valid option for the treatment of exotropia and ptosis in patients with third cranial nerve palsy.