Insertion Of Superior Rectus Muscle Research Articles

Combined Rectus Muscle Transposition With Posterior Fixation Sutures (Augmented Knapp Procedure) for the Surgical Treatment of Double Elevator Palsy.

To evaluate the surgical results of full horizontal tendon rectus muscle transposition to the superior rectus muscle insertion, augmented by posterior fixation sutures, in patients with double elevator palsy. In this retrospective comparative study, 17 patients treated by the augmented Knapp procedure (study group) were compared with 28 patients treated by the standard Knapp procedure (control group). Pre-operative and postoperative vertical deviation in primary position, ocular motility, binocular function, and rate of reoperation were evaluated. The mean preoperative near and distance deviations (hypotropia) decreased by 93% and 97% in the study group and 68% and 69% in the control group, respectively. The improvement in near and distance deviation was statistically more significant in the study group than the control group (P = .001 for each parameter). The mean preoperative elevation deficiency in abduction and adduction improved by 64% and 66% in the study group and 37% and 39% in the control group, respectively. The improvement in elevation deficiency in abduction and adduction was statistically significantly greater in the study group than the control group (P = .001 and .04, respectively). Reoperation was required in 15 patients (54%) in the control group and 2 (12%) in the study group during the follow-up period of 26 ± 4 months. The postoperative improvement in near and distance deviation and elevation deficiency in abduction and adduction was significantly better in the augmented Knapp procedure than the standard Knapp procedure. This procedure demonstrated a stronger effect in the treatment of double elevator palsy. [J Pediatr Ophthalmol Strabismus. 2022;59(1):17-23.].

Superior rectus muscle insertion injury following cosmetic upper lid blepharoplasty: a case report

BackgroundDirect damage to the superior rectus (SR) muscle insertion following upper lid blepharoplasty has not been reported. We document a rare case of vertical diplopia due to direct damage to the SR muscle insertion following cosmetic upper lid blepharoplasty.Case presentationWe describe a case of 24-year-old woman with Asian eyelid. The patient had already undergone multiple cosmetic upper lid surgeries and complained of vertical diplopia immediately after her most recent surgery (levator resection with skin approach). Preoperatively, large-angle right hypotropia and severe upgaze limitation were present and noticeable ptosis was observed in the right eye. Intraoperatively, the SR muscle fibers were observed to be detached at the insertion site and severe fibrosis and adhesion surrounding the muscle was noted. After strabismus surgery, vertical strabismus was improved.ConclusionsThis case can provide valuable insight to surgeons performing ptosis surgery and blepharoplasty, particularly in cases of reoperation. Surgeons should be careful while manipulating the levator muscle or resecting deep tissues not to affect the SR muscle.

Detailed anatomy of the transverse superior fascial expansion of the upper eyelid.

This study was designed to elucidate the detailed anatomy of the transverse superior fascial expansion (TSFE) and its relationship to the superior rectus muscle (SRM) and the levator palpebrae superioris (LPS). In this cohort study, 46 eyes of 23 cadavers were observed macroscopically. Dissection from the SRM origin to its insertion was performed, and the width, length, and tensile strength of the TSFE were determined. The TSFE was located between the LPS and SRM. It originated at the surface of the SRM, 32.75 ± 4.40 mm from the origin of the SRM, and extended anteriorly. The TSFE firmly adhered to the SRM surface, 1.53 ± 0.47 mm medially and 1.19 ± 0.19 mm laterally, extended upwards and anteriorly, and inserted to the under surface of the LPS. The TSFE width was 6.70 ± 1.17 mm at the origin site on the SRM surface and 11.42 ± 6.70 mm at the insertion site on the LPS under the surface. Its total length was 11.67 ± 0.87 mm medially and 11.55 ± 0.94 mm laterally The TSFE was first encountered 11.49 ± 1.17 mm laterally and 11.57 ± 1.27 mm medially from the SRM insertion on the SRM's anterior surface. The tensile strength of the TSFE was significantly greater than that of the intermuscular fascia between the SRM and LPS (9.74 ± 4.53 N vs 3.02 ± 1.85 N, P =0.001). This study provides a good understanding of the TSFE structures conducive to performing SRM surgery.

An interesting case of bilateral bifid insertion of superior rectus muscle as an intra-operative finding in a patient with oculocutaneous albinism

We report a case of bilateral bifid insertion of superior rectus muscles, in a patient with oculocutaneous albinism as an incidental intraoperative finding during eye muscle surgery. The muscle was successfully operated on and the patient did well postoperatively. To our knowledge, this is the first report of this anomaly.

Surgical implications of the superior oblique frenulum

The superior oblique frenulum is a fascial membrane that prevents substantial separation of the superior rectus muscle and SO tendon. In three patients, the superior rectus muscle was disinserted and temporarily suspended 6, 8, 10, 12, and 14 mm in random order from its insertion. The change in position of the anterior edge of the superior oblique tendon from the superior rectus muscle insertion was measured before and after severing the frenulum structure. In four other patients undergoing superior oblique recession, the superior oblique tendon was disinserted at its insertion temporally. The amount of recession that spontaneously occurred was measured before and after severing the frenulum. In the first group, there was essentially a one-to-one correlation between the posterior movement of the superior oblique tendon and the amount of superior rectus recession for recessions up to 10 mm. After severing the frenulum, the anterior portion of the superior oblique tendon was positioned less posteriorly. It measured less than 1.2 mm for superior rectus recessions up to 14 mm. For the second group, the mean suspension distance of the cut end of the disinserted superior oblique tendon was 2.4 +/- 0.4 mm before stripping the frenulum as compared with 8.5 +/- 0.7 mm after stripping the frenulum (Student's t-test, p = 0.0011). The frenulum pulls the superior oblique tendon posteriorly as the superior rectus muscle is recessed and constrains the superior oblique tendon after disinsertion. How this connection is handled at the time of surgery may have implications for superior rectus recessions and superior oblique tendon surgery.

Superior Oblique Tendon Incarceration Syndrome

To describe the clinical features, etiology, and management of superior oblique tendon incarceration syndrome. This series consists of all patients I treated between September 15, 1974, and March 1, 2006, for restrictive hypertropia in which the superior oblique tendon was found scarred to the superior rectus muscle insertion after prior surgery. Twenty eyes in 18 patients were included in this series. The mean+/-SD hypertropia of the affected eye was 15.4+/-9.0 prism diopters, and the mean+/-SD incyclotropia was 15.0 degrees+/-3.5 degrees. Causes of superior oblique tendon incarceration syndrome included prior superior rectus muscle resection, recession, plication, or transposition; superior oblique tendon recession, disinsertion, or posterior tenectomy; and scleral buckling surgery. The syndrome was difficult to treat and required a mean+/-SD of 1.9+/-0.7 additional surgical procedures to correct. Superior oblique tendon incarceration syndrome is a complication of surgery on the superior rectus muscle or superior oblique tendon that can result in restrictive hypertropia and incyclotropia. Proper handling of the connection between the superior oblique tendon and superior rectus muscle at the time of surgery may prevent this complication, which can be difficult to treat.

Extraocular muscle cysticercosis mimicking idiopathic orbital inflammation: case report

Presentation of one case of extraocular muscle enlargement caused by cysticercosis, its clinical, diagnostic and treatment aspects, and review of the literature on this theme. A female 38-year-old patient with extraocular muscle enlargement and a small cystic lesion at the superior rectus muscle insertion was treated with oral prednisone for almost one year, with a non-specific inflammation of right orbit diagnosis. There were important ocular motility restriction and pain. Computerized tomography disclosed a superior rectus muscle thickening with a small cystic and apparently empty lesion at the muscle's insertion. Excisional biopsy and histopathological study confirmed the clinical suspicion of cysticercosis. There was partial resolution of the restricted motility. Extraocular muscle cysticercosis is the most common site of this disease when involving the orbit. Oral albendazole and prednisone are efficient, but a long history of disease can lead to important residual ocular motility restriction.

Surgical implications of the superior oblique frenulum

Introduction: The superior oblique frenulum is a fascial membrane that prevents significant separation of the superior rectus muscle and superior oblique tendon. In this case series, we measured the effect of severing this frenulum on the relative positions of the superior oblique tendon and superior rectus muscle when recessed. Methods: In three patients, the superior rectus was disinserted and suspended 6, 8, 10, 12, and 14 mm from its insertion. The posterior excursion of the anterior edge of the superior oblique tendon from the superior rectus muscle insertion was measured before and after severing the frenulum structure.

Nodular Fasciitis Presenting as a Rapidly Enlarging Episcleral Mass in a 3-Year-Old

A rapidly enlarging periocular mass in a child obligates the treating physician to rule out a malignancy, especially a rhabdomyosarcoma. A 3-year-old girl presented with a 5-day history of a rapidly growing episcleral mass superonasal to the globe, adjacent to the superior rectus muscle insertion. The lesion was locally excised. A sarcoma could not be excluded on frozen sections. Permanent sections and electron microscopy revealed nodular fasciitis, a benign lesion with a pseudosarcomatous histologic appearance. No recurrence has been noted at 9 months follow-up. Nodular fasciitis is a benign proliferation which should be considered in the differential diagnosis of a rapidly enlarging subconjunctival or orbital mass in a child.

Dissociated vertical deviation. Treatment with the faden operation of Cuüppers.

Thirty-four patients (49 eyes) who had dissociated vertical deviation were treated with faden operation of Cüppers. The median follow-up period was 14 months. The operation produced good results in 23 of the patients, some improvement in seven, and did not help four. The posterior fixation suture was placed 14 mm behind the superior rectus muscle insertion and the superior rectus muscle was recessed.