Inferior oblique underaction: a transient complication related to inferior orbital wall fracture in childhood.
Summary of "Inferior oblique underaction: a transient complication related to inferior orbital wall fracture in childhood."
Purpose:  To evaluate inferior oblique (IO) underaction related to orbital floor fracture and its management. Methods:  We retrospectively assessed 137 patients with orbital floor fractures who had undergone surgical repair between July 2003 and August 2009. Review of clinical data, which included photographs and radiologic findings, was performed. IO underaction was diagnosed based on anomalous head position and which was confirmed with the Hess test and limitation of duction and version in the nine diagnostic positions of gaze. Results:  Twelve patients demonstrated IO underaction pattern (8.8%); 3 patients presented preoperatively and 9 patients presented postoperatively. All the patients showed IO underaction pattern in the Hess test and head tilt position. The median age was 9.5 years (range, 6-24 years), and all the patients were male. Of 12 patients, 10 (85%) presented with nausea and vomiting symptoms, 2 (17%) infraorbital hypoesthesia, and 3 (25%) pupillary dilatation. On the basis of the CT scans, all patients had trap door fractures with soft tissue entrapment. The IO underaction recovered spontaneously within 2 months without any treatment. Conclusion:  Head tilt towards the injured side can be a warning sign of IO underaction in orbital floor fracture, especially pre- or postoperatively in the paediatric population. Physicians managing paediatric orbital fracture should be aware of this transient complication.
Affiliation
Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Kim's Eye Hospital, Seoul, Korea.
Journal Details
This article was published in the following journal.
Name: Acta ophthalmologica
ISSN: 1755-3768
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22690727
- DOI: http://dx.doi.org/10.1111/j.1755-3768.2012.02466.x
Medical and Biotech [MESH] Definitions
Oculomotor Muscles
The muscles that move the eye. Included in this group are the medial rectus, lateral rectus, superior rectus, inferior rectus, inferior oblique, superior oblique, musculus orbitalis, and levator palpebrae superioris.
Oculomotor Nerve Diseases
Diseases of the oculomotor nerve or nucleus that result in weakness or paralysis of the superior rectus, inferior rectus, medial rectus, inferior oblique, or levator palpebrae muscles, or impaired parasympathetic innervation to the pupil. With a complete oculomotor palsy, the eyelid will be paralyzed, the eye will be in an abducted and inferior position, and the pupil will be markedly dilated. Commonly associated conditions include neoplasms, CRANIOCEREBRAL TRAUMA, ischemia (especially in association with DIABETES MELLITUS), and aneurysmal compression. (From Adams et al., Principles of Neurology, 6th ed, p270)
Oculomotor Nerve
The 3d cranial nerve. The oculomotor nerve sends motor fibers to the levator muscles of the eyelid and to the superior rectus, inferior rectus, and inferior oblique muscles of the eye. It also sends parasympathetic efferents (via the ciliary ganglion) to the muscles controlling pupillary constriction and accommodation. The motor fibers originate in the oculomotor nuclei of the midbrain.
Mediastinal Cyst
Cysts of one of the parts of the mediastinum: the superior part, containing the trachea, esophagus, thoracic duct and thymus organs; the inferior middle part, containing the pericardium; the inferior anterior part containing some lymph nodes; and the inferior posterior part, containing the thoracic duct and esophagus.
Inferior Wall Myocardial Infarction
MYOCARDIAL INFARCTION in which the inferior wall of the heart is involved. It is often caused by occlusion of the right coronary artery.
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