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      Die Zügeloperation bei inkompletter Okulomotoriusparalyse (Rectus-superior- und Rectus-lateralis-Transposition nach nasal unten) Translated title: Bridle operation for incomplete oculomotor nerve paralysis (superior rectus and lateral rectus nasal inferior transposition)

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          Abstract

          Ziel

          Demonstration der Technik und Wirksamkeit der Zügeloperation bei Okulomotoriusparalyse mit erhaltener Hebungsfähigkeit.

          Methode

          Transposition der Mm. recti lateralis (hinter Mm. obliquus und rectus inferior) und superior (hinter Obliquus-superior-Sehne und M. rectus medialis) in den nasal unteren Quadranten.

          Ergebnisse

          Im exemplarisch dargestellten Fall korrigierte der Eingriff ohne wesentlichen Verrollungseffekt eine paralytische Exo-Hypertropie von 30–40°/20–30°.

          Schlussfolgerung

          Die Zügeloperation erweitert das chirurgische Repertoire zur Korrektur paralytischen Schielens.

          Translated abstract

          Purpose

          To demonstrate the technique and effectiveness of the bridle operation for oculomotor nerve paralysis with maintained elevation.

          Method

          The bridle operation includes transposition of the lateral rectus muscle (passing behind inferior oblique and rectus muscles) and the superior rectus muscle (behind superior oblique tendon and medial rectus muscle) to the nasal inferior surface of the globe.

          Results

          In the reported case, this procedure corrected exo-hypertropia of 30–40°/20–30° without inducing cyclotropia.

          Conclusion

          The bridle operation expands the surgical arsenal for paralytic strabismus.

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          Most cited references20

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          Surgical management of oculomotor nerve palsy with lateral rectus transplantation to the medial side of globe.

          J N Taylor (1989)
          An operation for complete third nerve paralysis involving lateral rectus muscle transplantation to the medial side of the globe as a basic procedure is described. An inferior rectus muscle recession plus resection of an apparent completely paralysed medial rectus was subsequently performed at a second stage operation. The results appeared to be an improvement on previous surgery, particularly in terms of ocular motility, with almost full adduction of the operated eye being achieved. This adduction movement occurred as part of a normal conjugate movement of the two eyes, and the question arises as to the responsible muscles, with some evidence to suggest that relearned action of the transplanted lateral rectus muscle may be implicated. Finally, a Fasanella-Servat procedure as a third stage operation appeared to be adequate to correct the ptosis.
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            ["Lateralis splitting" in total oculomotor paralysis with trochlear nerve paralysis].

            In two cases of 3rd nerve palsy and trochlear palsy we performed a new transposition procedure. This procedure consists of splitting of the lateral rectus muscle and transposition of the upper half to a retroequatorial point near the nasal superior vortex vein. The lower half is transposed to a retroequatorial point near the nasal inferior vortex vein. In the first case we linked the two halves with fascia late. The horizontal deviation was diminished by 15-20 degrees.
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              Oculomotor nerve palsies in children.

              Fifty-four patients with oculomotor nerve palsy who presented over a 21-year period at our institution were reviewed retrospectively. There were 38 isolated third nerve lesions, and 16 with additional cranial nerve involvement. Eleven cases were congenital in origin, and 43 were acquired. Of the acquired group, 31 were traumatic, 7 infection-related, 3 attributed to migraine or other vascular causes, and 2 neoplastic. Average follow up was 36 months. The congenital lesions were predominantly right-sided; amblyopia, although common, responded well to treatment. Trauma and bacterial meningitis accounted for more cases of isolated oculomotor nerve palsy than seen in the previous literature. In distinct contrast to the adult population, no cases of diabetes, posterior communicating artery aneurysms, metastatic tumors, or pituitary lesions were found.
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                Author and article information

                Contributors
                michael.h.graef@augen.med.uni-giessen.de
                Journal
                Ophthalmologe
                Ophthalmologe
                Der Ophthalmologe
                Springer Medizin (Heidelberg )
                0941-293X
                1433-0423
                1 March 2021
                1 March 2021
                2021
                : 118
                : 11
                : 1113-1118
                Affiliations
                GRID grid.411067.5, ISNI 0000 0000 8584 9230, Klinik und Poliklinik für Augenheilkunde, , Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, ; Friedrichstr. 18, 35392 Gießen, Deutschland
                Article
                1339
                10.1007/s00347-021-01339-y
                8568859
                33649921
                b3f85dad-8a4a-46d8-a80b-fed853465561
                © The Author(s) 2021

                Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden.

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                History
                : 6 December 2020
                : 16 January 2021
                : 29 January 2021
                Funding
                Funded by: Justus-Liebig-Universität Gießen (3114)
                Categories
                Übersichten
                Custom metadata
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021

                augenmuskelchirurgie,okulomotoriusparese,paralytisches schielen,transpositionsoperation,nasale transposition,extraocular muscle surgery,strap operation,oculomotor nerve palsy,paralytic strabismus,nasal transposition

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