Treatment of Paralysis of the VIth Nerve: Evaluation of Transposition Surgeryof the Oculomotor Muscles according to Hummelshein

Overview

The authors evaluated in a retrospective study the results of surgery in 28 patientswith paralysis of the VIth cranial nerve. The standard surgical procedure whichwas selected as primary achieved orhtophoria in 21 patients. In 7 patients withpersisting esotropia and diplopia transposition of the oculomotor nerves according to Hummelshein was indicated. After stabilization of the postoperativefinding in all patients parallel position of the eyes and a improved compensatoryposition of the head was found. Markedly restored motility in abduction wasobserved only in patient. The method of first choice in treatment of paralysis ofthe sixth nerve but also of other oculomotor nerves are standard surgical procedures. By retroposition and resection of oculomotor muscles usually a satisfactory state in the primary position is achieved. Transposition operations arerather useful as supplementary operations in previously operated eyes. Indicattions are persisting diplopia and esotropia. Postoperative results as regards theprimary position of the eyes are satisfactory but usually marked improvement ofthe motility cannot be foreseen.

Key words:
Paralysis of the VIth cranial nerve, retroposition and resection ofoculomotor muscles, ischaemia of the anterior segment, transposition surgery,Botulotoxin A