PREOPERATIVE DIAGNOSIS:
oblique overaction.
POSTPROCEDURE DIAGNOSIS:
oblique overaction.
OPERATION PERFORMED:
Right cranial nerve IV paresis with inferior
Right cranial nerve IV paresis with inferior
Right inferior oblique myectomy.
ATTENDING AND RESPONSIBLE SURGEON:
ASSISTANT:
Douglas Fredrick, M.D.
Suzann Pershing, M.D.
INDICATIONS: The patient is a 2-year-old girl with a history of
constant head turning to the left. On examination, she has marked
inferior oblique overaction on the right side. Risks, benefits,
alternatives, and complications with special emphasis on
overcorrection, undercorrection in terms of any need for additional
muscle surgery were discussed at length with the parents who wished to
proceed.
DESCRIPTION OF PROCEDURE: Patient brought to the operating room where
general anesthesia induced by Anesthesia Staff. At this time, forced
duction testing revealed laxity in all extraocular muscles, not just
the superior oblique muscle. The eye was prepped and draped in sterile
ophthalmic fashion using Betadine. Forced duction testing was
performed, which revealed laxity in all extraocular muscles. A
traction suture with 6-0 silk was placed at 6 and 9 o'clock limbus.
The eye was rotated into elevation and adduction. An incision was made
8 mm in the inferotemporal quadrant. Using a direct visualization, the
inferior oblique muscle was isolated on Graefe muscle hooks and green
muscle hooks. Care was taken to incorporate all fibers on the
dissection. Additional Graefe hooks were used to isolate the inferior
rectus and lateral rectus muscle to make certain the inferior oblique
was properly identified. After identification was confirmed, the
muscle hooks were splayed apart 8 mm. Then, 2-stage hemostats were
used across the muscle between 8 mm. Westcott scissors were used to
create a myectomy. The ends of the cut muscle were treated with
cautery. The muscle clamps were removed and the muscle retracted
quickly in the orbit, indicating all fibers had been cut. This
fashioned a right inferior oblique myectomy of 8 mm. The conjunctiva
was closed with 6-0 plain gut suture.
The patient was awakened and taken to the PACU in stable condition
after TobraDex ointment was placed in the eye.