Transcaruncular rectus tendon fixation to the orbit and frontalis flap for complete third nerve palsy

ABSTRACT

Purpose: To describe our experience and outcomes managing complete third cranial nerve palsy.

Methods: This was a retrospective analysis of the clinical records of 7 consecutive patients treated at our centre for unilateral third nerve palsy over the period 2010–2016. We describe our surgical approach using a frontalis muscle flap to correct the eyelid ptosis associated with medial fixation of the rectus muscle tendon to the orbit to correct the horizontal deviation.

Results: The seven patients, four women and three men, were of mean age of 44 ± 19 years [18–75 years]. Follow up was 29 ± 31 months [5–82 months]. In the preoperative exam, exotropia in prism diopters (PD) was −70 ± −28 PD [−30 to −90 PD]. At the end of follow up, this was reduced to −11 ± −14 PD [0 to −30 PD]. Preoperative marginal reflex distance 1 (MRD1) was −4 ± 1 mm [−3 to −5 mm] and palpebral fissure height (PFH) was 0.5 ± 1 mm [0–2 mm]. Surgical undercorrection was the target in all patients due to the absent or poor Bell’s phenomenon. At the end of follow up, MRD1 was 2.5 ± 0.5 mm [2–3 mm] and PFH was 7 ± 1 mm [6–8 mm]. Cosmetic and functional results were good in all patients.

Conclusions: Medial fixation of the rectus muscle tendon to the orbit associated with a frontalis muscle flap is a valid option for the treatment of exotropia and ptosis in patients with third cranial nerve palsy.

KEYWORDS:

• Orbit
• ptosis
• exotropia
• frontalis flap
• third nerve palsy

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.