Fibrotic superior oblique and superior rectus muscles with an accessory tissue band

Özkan, Seyhan B.; Çakmak, Harun; Dayanir, Volkan

doi:10.1016/j.jaapos.2007.05.005

Cited by 8 publications

(3 citation statements)

References 8 publications

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“…Similarly located anomalous EOM bands have been detected by other authors and given names such as the levator palpebrae superioris accessorius muscle, or muscle tensor trochleae of Budge 5,6. While this levator-trochlea muscle appears to be the most commonly recognized supernumerary EOM in the literature, case reports have documented others including a band between the IR and the globe,7 a band between the levator palpebrae superioris and the globe,8 and an accessory LR 9…”

Section: Discussionsupporting

confidence: 58%

“…However, intraoperative observation of sustained restriction to supraduction after IR release supports the notion that the anomalous band was indeed a substantial contributor to the patient's strabismus. Other prior reports have similarly suggested that these anomalous bands may be pathologic in some instances and have implicated them as causing restrictive strabismus, globe retraction, and eyelid retraction 6,8,10. Because these bands are often located deep in the orbit, they are difficult to access using traditional strabismic surgical approaches.…”

Section: Discussionmentioning

confidence: 98%

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Magnetic Resonance Imaging of Tissues Compatible with Supernumerary Extraocular Muscles

Khitri

Demer

2010

American Journal of Ophthalmology

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PURPOSE To determine by magnetic resonance imaging (MRI) the prevalence and anatomy of anomalous EOM bands. DESIGN Prospective, observational case series. METHODS High resolution, multi-positional, surface coil orbital MRI was performed using T1 or T2 fast spin echo weighting with target fixation control under a prospective protocol in normal adult subjects and a diverse group of strabismic patients between 1996 and 2009. Images demonstrating anomalous EOM bands were analyzed digitally to evaluate their sizes and paths, correlating findings with complete ophthalmic and motility examinations. RESULTS Among 118 orthotropic and 453 strabismic subjects, one (0.8%) orthotropic and 11 (2.4%) strabismic subjects exhibited unilateral or bilateral orbital bands having MRI signal characteristics identical to EOM. Most bands occurred without other EOM dysplasia and coursed in the retrobulbar space between rectus EOMs such as medial (MR) to lateral rectus (LR), or superior (SR) to inferior rectus (IR), or from one EOM to the globe. In two cases, horizontal bands from MR to LR immediately posterior to the globe apparently limited supraduction by collision with the optic nerve. All bands were too deep to be approached via conventional strabismus surgical approaches. CONCLUSIONS About 2% of humans exhibit on MRI deep orbital bands consistent with supernumerary EOMs. While band anatomy is non-oculorotary, some bands may cause restrictive strabismus.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 98%

Magnetic Resonance Imaging of Tissues Compatible with Supernumerary Extraocular Muscles

Khitri

Demer

2010

American Journal of Ophthalmology

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“…There are many reports of aplasia or dysplasia of the extraocular rectus muscles [4][5][6][7][20][21][22][23][24][25][26] and of anomalous insertions. 1,16,[27][28][29][30][31] However, none of our fetuses had these anomalies, probably owing to the limited numbers of specimens we examined. Likewise, we did not find the well-known insertion anomaly of the LR, (i.e., a retractor bulbi that is an additional slip of the LR and provides a muscular funnel around the optic nerve's exit from the eye ball).…”

Section: Discussionmentioning

confidence: 99%

Examination of the Annular Tendon (Annulus of Zinn) as a Common Origin of the Extraocular Rectus Muscles: 2. Embryological Basis of Extraocular Muscles Anomalies

Kim

Hayashi

Yamamoto

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. Many reports have described anomalous connections of the superior rectus (SR) with other extraocular rectus muscles, in which additional heads of the other three rectus muscles likely provided the connections. We examined how these connections are established during fetal development. METHODS. We analyzed paraffin-embedded horizontal sections from 25 late-stage fetuses. Horizontal sections are best suited for understanding the mediolateral relationships of muscle origins. RESULTS. We confirmed a common tendinous origin of the lateral rectus (LR), inferior rectus (IR) and medial rectus (MR) muscles that was separated from the SR origin. Notably, eight fetuses (32%) had tendinous or muscular connections between the SR and other rectus muscles that had one of four morphologies: (a) a thin tendon from the SR to the common tendon of the three rectus muscles (2 fetuses), (b) a thin tendon to the LR (one fetus), (c) a thin tendon to the inferior rectus muscle origin (two fetuses), and (d) SR muscle fibers arising from an additional head of the LR (three fetuses). CONCLUSIONS. The SR seemed to issue a thin tendon that passed along the inferior or lateral side of the oculomotor nerve. Conversely, the LR and inferior rectus muscle were likely to carry a supernumerary bundle that reached the SR. The accessory head of the medial rectus muscle showed a stable morphology in that it seemed to also provide an anomalous double head. However, the presence of an accessory head in the LR was rare. In contrast with our previously published diagram of the orbital apex, the accessory head of the medial rectus muscle passed along the lateral side of the superior oblique.

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Clinical Characteristics and Surgical Outcomes of Patients with Congenital Fibrosis of the Superior Rectus Muscle

Yang

Yan

2022

Ophthalmol Ther

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Introduction: Congenital fibrosis of superior rectus muscle (CFSRM) is extremely rare and a difficult condition to manage surgically. The purpose of this report is to summarize the clinical characteristics of patients with CFSRM and analyze the effects of its surgical management. Methods: Records of nine CFSRM patients were retrospectively reviewed and their clinical features including age, gender, visual acuity, refraction, ocular alignment, ocular motility, surgical method employed and final outcomes were analyzed. Results: All cases were monocular. There were four cases (44.4%) coexistent with fibrosis of the levator palpebrae muscle and three (33.3%) with fibrosis of the superior oblique muscle. Eight cases (88.9%) presented with hypertropia, and one case showed mild hypotropia.Horizontal deviation was presented in six cases (66.7%). Surgical approaches included either superior rectus recession/tenotomy with or without traction suture; superior rectus recession and inferior rectus resection; or adhesion separation of superior rectus and levator palpebrae muscles. Excellent surgical outcomes were obtained in five cases (55.6%), good in two (22.2%), and poor outcomes were reported for two cases (22.2%). One patient (11.1%) underwent a second surgery. Conclusion: CFSRM was found to be mainly unilaterally infected, mostly manifesting as hypertropia, and was often associated with fibrosis of the levator palpebrae or superior oblique muscle. Weakening procedures of the superior rectus muscle were the preferred surgical technique. However, success rates were relatively low for CFSRM.

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Fibrotic superior oblique and superior rectus muscles with an accessory tissue band

Cited by 8 publications

References 8 publications

Magnetic Resonance Imaging of Tissues Compatible with Supernumerary Extraocular Muscles

Magnetic Resonance Imaging of Tissues Compatible with Supernumerary Extraocular Muscles

Examination of the Annular Tendon (Annulus of Zinn) as a Common Origin of the Extraocular Rectus Muscles: 2. Embryological Basis of Extraocular Muscles Anomalies

Clinical Characteristics and Surgical Outcomes of Patients with Congenital Fibrosis of the Superior Rectus Muscle

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