Brief surgery types + surgical considerations

Question 1

Strengthening procedures

Answer 1

Resect
Tuck

Question 2

Weakening procedures

Answer 2

Recess
Tenotomy/ Tenectomy
Myectomy
Tendon spacer ( A pattern)

Question 3

Transposition procedures

Answer 3

Harado Ito
Antero- medial (SO)
Foster
Hummelsheim
Jensen
Knapp

Question 4

Considerations before surgery

Answer 4

▪ Extent of muscle sequelae
▪ Surgery confined to muscles of muscle sequelae, where some function is present, strengthen the affected muscle + u/a contralateral antagonist.
Increased chance of achieving a useful field of BSV.
▪ Weaken the o/a Muscle (contralateral synergist + ipsilateral antagonist.)
▪ Suitability of each muscle for type of surgery
▪ Size of deviation in P.P. and down gaze.
▪ Consider A or V patterns
▪ Presence of horizontal/ vertical componentsx
▪ Presence and amount of torsion
▪ Paralysis (Complete) / paresis (Incomplete)
▪ No function – avoid or transposition procedure
▪ Longstanding / recently acquired
▪ Fusion amplitude
▪ AHP
▪ Forced duction test (FDT)
▪ Surgery may be performed in stages (to assess the outcome of each individual stage), or at one stage (dependent upon the extent of the palsy)
▪ Botulinum toxin may be used in conjunction with muscle surgery.