Specialized Surgical Procedures for Management of Cranial Nerve Palsies

Abstract

Background and Purpose

Surgical correction of cranial nerve palsies involves balancing unequal muscle forces. Conventional recess/resect techniques used in non-paralytic strabismus may not be sufficient. Special surgical procedures are available that may improve outcomes.

Methods

Literature review and the author's experience.

Results

The surgical goal of re-establishing ocular alignment and restoring a functional diplopia-free field depends upon the degree of muscle paralysis and the number of muscles involved. A recess/resect/adjustable suture technique used to correct a single paretic (weakened) muscle may afford the patient complete or nearly complete function. A single totally paralyzed muscle may require additional procedures such as a transposition. However, the best possible outcome will still compromise ocular rotations and the diplopia-free field. Multiple muscle involvement complicates the issue even further. Other specialized procedures may be required. The outcome, at best, may be alignment in the primary position with a minimal range of binocular function.

Conclusion

A variety of specialized techniques are available to the strabismus surgeon in designing a successful treatment plan for cranial nerve palsies. In general, the success of surgery for paretic muscles will be more favorable than for paralyzed muscles. With careful attention to diagnosis and surgical planning, favorable outcomes can be maximized.

• third
• fourth
• sixth cranial nerve palsy
• strabismus surgery