Abstract
Resumo A paralisia do terceiro nervo craniano representa o estrabismo paralitico de tratamento mais complexo e desafiador. Os casos de paralisia completa III par incitam o uso de certas tecnicas de cirurgia de estrabismo destinadas a manter o olho voltado para a posicao primaria do olhar (PPO). Entretanto, as possibilidades terapeuticas sao limitadas e complexas e o tratamento cirurgico tende a hipocorrecao e recorrencias frequentes a longo prazo.O envolvimento completo e congenito do terceiro nervo craniano requer cirurgias para a exotropia, hipotropia e ptose.Dentre as tecnicas cirurgicas ja descritas, optou-se pela realizacao de uma modificacao da tecnica cirurgica de recuo-resseccao, que deu-se em unico tempo cirurgico, sendo suficiente para alcancar o objetivo estetico. Este trabalho relata o resultado positivoda manutencao de sutura de tracao a caruncula para tratamento cirurgico de estrabismo paralitico congenito de nervo oculomotor de longa data.
Highlights
Congenital and isolated paralysis of the third nerve is rare, usually unilateral and may occur alone or in association with other neurological and systemic abnormalities.[1,2] The most frequently mentioned mechanism is perinatal injury to the third peripheral nerve
The present study reports the entire approach of a case of congenital paralysis of the third nerve, from the anamnesis, physical examination, surgical plan preparation, and surgical treatment to the analysis of the result for the correction of strabismus resulting from this ocular pathology
Daniell et al concluded that supra-maximal horizontal recession-resection combined with traction sutures left over for six weeks is a procedure that restores the eye to PPE, becoming a procedure of choice in a case of fixed differential strabismus.[19]
Summary
Congenital and isolated paralysis of the third nerve is rare, usually unilateral and may occur alone or in association with other neurological and systemic abnormalities.[1,2] The most frequently mentioned mechanism is perinatal injury to the third peripheral nerve. (5) In addition, the lateral rectus in the affected eye, unopposed to its action, will initially keep the eye in divergent position against the orbital static forces that try to bring it back to the center.[6]
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