superior oblique muscle transposition

Paralytic oblique strabismus must first find out what muscle paralysis? General paralysis or partial paralysis? Congenital or acquired? If acquired, is the cause clear? Then the surgical plan can be developed. The following is a surgery for complete extraocular muscle paralysis. The effect of paralytic oblique strabismus surgery is not satisfactory, only the basic orthotopic position can be made, and the double vision interference can be reduced. These should be explained in detail to the patient. Treatment of diseases: paralytic strabismus Indication The superior oblique muscle transposition is suitable for the paralysis of the upper, lower, medial rectus and inferior oblique muscles caused by the third cranial nerve palsy, and the diseased eye is in an external oblique state. Contraindications If the oblique muscle function is poor or not, the surgical effect is minimal. Surgical procedure 1. The limbal incision cuts the conjunctiva at 1.5 mm outside the limbus at 12 o'clock and extends to 3 o'clock. The bulbar conjunctiva was cut radially from the 12th and 3 o'clock, and the length was 5-7mm. 2. Expose the upper and inner rectus muscles. 3. Use the squint hook to hook the superior oblique muscle. 4. Use a sharp knife or a fine-tipped hemostat to follow the upper oblique muscle to the pulley and break it to disengage the superior oblique muscle from the pulley. This method of breaking the pulley is difficult to operate and is susceptible to damage to the superior oblique muscle tendon. Improved by Scott, there is no need to break the pulley, and the effect is better. 5. Cut the superior oblique muscle at the lateral edge of the superior rectus muscle. 6. Place the eyeball in a slightly upward and slightly inward position, and then fix the upper oblique muscle to the inner edge of the inner rectus muscle attachment point. Or 2 to 3 mm inside the upper rectus adhesion point (Scott). Cut off the excess superior oblique muscle. 7. Suffering from the extraocular rectus muscle after migration 14 ~ 16mm. 8. The rectus muscle in the eye is shortened by 6 to 8 mm. 9. If necessary, the healthy eye level after migration and shortening.