title: Iatrogenic inferior oblique palsy: intentional disinsertion during transcaruncular approach to orbital fracture repair.
abstract: Hypotropia following orbital fracture repair is traditionally attributed to residual tissue entrapment, scarring, direct muscle injury, or damage to the branches of the oculomotor nerve serving the inferior oblique or inferior rectus muscles. We present a case of acquired hypotropia and incyclotropia that occurred following repair of an orbital fracture involving the floor and medial wall. In order to enable adequate visualization and treatment of the combined fractures, access via a transcaruncular approach and disinsertion of the inferior oblique muscle at its origin was necessary. Whereas the possibility of inferior oblique paresis due to repair of an orbital fracture via the transcaruncular approach has received some acknowledgment, there are no prior reports in the ophthalmic literature. Strabismus surgeons should be aware of this possibility when planning surgical correction of hypotropia and incyclotropia in similar cases.
authors.affiliation: Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Tiedemann
authors.affiliation: Division of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Lefebvre
authors.affiliation: Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wan
authors.affiliation: Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts. Electronic address: Linda.Dagi@childrens.harvard.edu.
authors.forename: Linda R
authors.initials: LR
authors.lastname: Dagi
mesh_terms: D000328:Adult; D001484:Baseball / Q000293:injuries; D004172:Diplopia / Q000209:etiology* / Q000601:surgery; D005094:Exophthalmos / Q000209:etiology / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D015835:Ocular Motility Disorders / Q000209:etiology* / Q000601:surgery; D009801:Oculomotor Muscles / Q000000981:diagnostic imaging / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013536:Suture Techniques; D058971:Tenotomy; D014057:Tomography, X-Ray Computed