A Review of Transposition Techniques for Treatment of Complete Abducens Nerve Palsy

Akbari, Mohammad Reza; Masoomian, Babak; Mirmohammadsadeghi, Arash; Sadeghi, Motahhareh

doi:10.4103/joco.joco_42_21

Cited by 5 publications

(13 citation statements)

References 83 publications

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“…The management of paralytic strabismus presents a challenge for ophthalmologists, particularly in complex cases such as long-standing esotropia with severe muscle atrophy [ 19 , 20 ]. For complete sixth nerve palsy, currently, VRT procedures are the first-line treatment [ 2 ]. They can maintain the LR ciliary arteries and enhance binocular vision field and abducting force.…”

Section: Discussionmentioning

confidence: 99%

“…They can maintain the LR ciliary arteries and enhance binocular vision field and abducting force. Despite some variability in results, several authors, including Hummelsheim, O’Connor, Jensen, and Foster, have described superior and inferior rectus transpositions on multiple occasions with notable deviation improvements [ 2 ]. In 1997, Foster introduced a modification known as posterior fixation of transposed muscles [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…When the temporal one-fourth width of the superior and inferior rectus bellies are fixed to the upper and lower one-fourth widths of the LR belly, respectively, using 6-0 nonabsorbable sutures at 7–8 mm posterior to the LR insertion, this is known as an intermuscular augmentation suture, or Wright modification [ 2 ]. New vertical and torsional deviation and ASI are possible side effects of these procedures [ 2 - 4 ]. Following the modified Nishida procedure, our patient achieved orthophoria in the primary position.…”

Section: Discussionmentioning

confidence: 99%

“…Choosing the best surgical strategy requires assessing the function of the lateral rectus (LR) muscle and angle of deviation. Nevertheless, LR function assessment may be impacted by medial rectus (MR) muscle contracture, resulting in an incorrect diagnosis of complete LR palsy [ 2 ]. Other tests that can distinguish between partial and complete LR palsies include the forced duction test, force generation test, saccadic velocity, botulinum toxin A (BTA) injection, and evaluation of the post-injection abduction facility [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, complete LR palsy necessitates a different strategy, with the main surgical objectives being the expansion of the binocular diplopia-free field, improvement of the abduction deficit, and eye alignment in primary position [ 4 , 6 ]. Complete sixth nerve palsy is now primarily treated with vertical rectus muscle transposition (VRT); the two most common VRT techniques are those of Jensen and Hummelsheim [ 2 ]. The procedures have equal effects and complication rates in managing esotropia due to chronic sixth nerve palsy [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Surgical management of chronic sixth cranial nerve palsy: case report and literature review

Hakimeh,

Shahraki,

Courtois

et al. 2024

Med Hypothesis Discov Innov Ophthalmol

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Background: Esotropia resulting from sixth cranial nerve palsy can substantially impact an individual’s visual acuity and overall quality of life. If the condition does not resolve in 6–10 months, surgical intervention may be necessary. Various muscle surgeries may be considered, with vertical rectus muscle transposition emerging as the primary option for treatment of complete palsy. However, this technique carries the risk of anterior segment ischemia and post-surgery deviations. Herein, we present a successful treatment of chronic complete sixth nerve palsy using a modified Nishida procedure, without splitting or tenotomy, and an adjunct botulinum toxin A (BTA) injection in the ipsilateral medial rectus muscle. Case Presentation: A 59-year-old woman with a history of traumatic sixth nerve palsy had previously undergone horizontal muscle strabismus surgeries. Following multiple left medial rectus recessions, lateral rectus resection, and BTA injections, esotropia persisted. The worsening of her condition led to emotional distress and impaired social interaction. Initial examination revealed marked esotropia and limited left eye abduction. Magnetic resonance imaging (SIGNA MR750w, GE Healthcare, Waukesha, WI, USA) of the left eye revealed a contracted medial rectus muscle and substantial atrophy of the left lateral rectus muscle. A modified Nishida procedure was performed with an injection of 3 units of BTA into the ipsilateral medial rectus muscle, resulting in improved ocular alignment and stable findings after nine postoperative months. Furthermore, we supported our successful outcome with a summary of similar reported cases of sixth nerve palsy managed using the modified Nishida procedure with or without adjunctive procedures. Conclusions: Following the modified Nishida procedure, the patient experienced a reduction in diplopia, improved ocular alignment and stability, and an increased binocular diplopia-free field. This case underscores the importance of an individualized approach to complex strabismus cases and highlights the modified Nishida procedure as a valuable tool in such circumstances. In the future, strabismus management will focus on refining personalized treatment and exploring innovative techniques for complex cases. Our success in using a combination of Nishida procedure and BTA injection should be further investigated in large-scale studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Surgical management of chronic sixth cranial nerve palsy: case report and literature review

Hakimeh,

Shahraki,

Courtois

et al. 2024

Med Hypothesis Discov Innov Ophthalmol

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Cranial Nerve Dysfunction in Patients with an Occipital Condyle Fracture: Underdiagnosis and Clinical Relevance

Thevis,

Derks,

Jansen

et al. 2024

J Neurol Surg B Skull Base

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Objectives This study aims to fill in the knowledge gap about patients with occipital condyle fractures (OCFs) and cranial nerve dysfunction (CND) and give advice about when to test the cranial nerves (CNs) and what to do when CND is diagnosed. Design A 14-year period observational, retrospective cohort study. Setting Level-I trauma center study. Participants All 119 surviving cases admitted with an OCF, whereof all 40 cases with either diagnosed CND (confirmed by clinical examination) or expected CND (reported observations high suspicious for CND) were selected for detailed data collection. Early death was the only exclusion criterion because of missing data and clinical irrelevance. Main Outcome Measures One-third of all surviving OCF patients have CND (n = 40/119, 33.6%), where three-quarters had more than one CN affected with a median of three CNs. Of the cases with a concomitant lateral skull base fracture (n = 24/40, 60%), one in three cases (36%, n = 13/36) had facial nerve palsy and nearly two in three cases (61%, n = 22/36) had hearing loss. Results The facial nerve was the most commonly diagnosed CND. Solitary OCF cases often had lower CND (n = 11/14). Fifty-eight percent of all CND cases with follow-up data (n = 19/33)—corresponding to one in six of all surviving OCF cases—had chronic CND sequelae. Conclusions Multiple and chronic CND is common in patients with an OCF. All CNs should be tested in those patients as soon as clinically possible, and testing should be repeated after 3 to 7 days and before discharge. Patients with CND should be counseled about their prognosis and be potentially referred to (e.g.) a speech and language therapist, ophthalmologist, neurologist, or otorhinolaryngologist for early treatment options.

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A Potentially Adjustable Modification of the Nishida Procedure

Tauscher,

Haynie,

Pineles

et al. 2023

Journal of Binocular Vision and Ocular Motility

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A Review of Transposition Techniques for Treatment of Complete Abducens Nerve Palsy

Cited by 5 publications

References 83 publications

Surgical management of chronic sixth cranial nerve palsy: case report and literature review

Surgical management of chronic sixth cranial nerve palsy: case report and literature review

Cranial Nerve Dysfunction in Patients with an Occipital Condyle Fracture: Underdiagnosis and Clinical Relevance

A Potentially Adjustable Modification of the Nishida Procedure

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