Abducens paralysis from the viewpoint of the ENT physician and skull base surgeon

Abstract

Among the nerves supplying the extraocular muscles, abducent nerve paralysis is the most common one resulting in double vision. Surveys confirm that the palsy is most often benign and transient. In most cases Ophthalmologist, Neurologist, Pediatrician and Physician are involved in diagnosis and treatment of this symptom. The Otorhinolaryngologist is needed in the least common cases of abducent nerve palsy due to intra- or extracranial diseases, for example trauma, inflammatory complications or tumors of the skull base. 12 patients (6 male, 6 female) with abducent nerve paralysis were seen and treated in the Department of Ear-Nose- and Throat Diseases, Head, Neck and Facial Plastic Surgery, Klinikum Fulda between 1984 and October 1999 and included in our series. Their records were evaluated and the main aetiology listed, was checked. An inflammatory process was the most common cause in 6 patients, one of them presented with otogenic meningitis and bilateral abducent nerve paralysis. In 4 patients neoplasm was the underlying pathology, in 1 patient head injury associated with temporal bone fracture and in 1 patient an orbital pseudotumor. Complete recovery of abducent nerve was achieved in 7 patients (58%). Using modern imaging techniques enables us to diagnose the aetiopathology of abducent nerve paralysis. Using modern imaging techniques, planning of therapeutic strategy and clarifying the prognosis of this symptom has improved considerably.