Numerical Aberrations of the Extraocular Muscles and the Levator Palpebrae Superioris: An Anatomical and Clinical Insight.

IF 1.2 4区 医学 Q3 OPHTHALMOLOGY Ophthalmic Plastic and Reconstructive Surgery Pub Date : 2024-10-10 DOI:10.1097/IOP.0000000000002807
Hatem A Tawfik, Omar Amro El Houssieny, Jonathan J Dutton
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Abstract

Purpose: To comprehensively review the literature about numerical aberrations of the orbital muscles of ocular motility (here referred to as extraocular muscles [EOMs]) and the levator palpebrae superioris (LPS).

Methods: The authors summarize the embryologic bases and the possible etiopathogenetic causes of numerical aberrations of the EOMs and the LPS and organize these lesions into several broad categories. The clinical and radiologic diagnostic challenges are discussed.

Results: Numerical aberrations of the EOMs include: 1) the complete absence of EOMs, 2) duplication of an entire EOM, 3) the presence of muscle bands that connect 2 EOMs, and 4) minor morphological variations such as bifid muscles (partial splitting of the muscle). Some cases may defy categorization into any of the above or may resemble atavistic remnants of the retractor bulbi muscle. Broadly speaking, numerical aberrations of the LPS generally fall into the same categories although the LPS has several peculiar numerical anomalies of its own.

Conclusions: Although numerical EOM and LPS variations are relatively rare and of little clinical significance, raising awareness about their presence is a fundamental clinical keystone not just for the strabismus surgeon but for the orbital surgeon as well. During orbital surgery, this may spare the surgeon from pursuing an orbital witch hunt for these benign innocuous accessory orbital structures that were accidentally discovered by the radiologist and misinterpreted as sinister etiologies. For the strabismus surgeon, the failure to identify them may result in an unfavorable surgical outcome if these structures are missed because of a lack of awareness despite being responsible for generating complex strabismus patterns or having a restrictive potential of their own.

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眼外肌和上睑提肌的数字畸变:解剖学和临床启示。
目的:全面综述有关眼球运动眶肌(此处称为眼外肌[EOMs])和上睑提肌(LPS)数字畸变的文献:作者总结了眼外肌和上睑提肌数字畸变的胚胎学基础和可能的病因,并将这些病变分为几大类。结果:EOMs的数字畸变包括结果:EOM 的数字畸变包括:1)EOM 完全缺失;2)整个 EOM 重复;3)存在连接 2 个 EOM 的肌带;4)轻微的形态变化,如二叉肌(肌肉部分分裂)。有些病例可能无法归类为上述任何一种情况,或者类似于牵张球部肌的残余。大体上说,LPS的数字畸变通常属于同一类别,尽管LPS本身也有几种特殊的数字异常:虽然EOM和LPS的数字变异相对罕见,临床意义也不大,但提高对其存在的认识不仅是斜视外科医生的临床基础,也是眼眶外科医生的临床基础。在眼眶手术过程中,这可能会使外科医生免于对这些良性无害的附属眼眶结构进行 "猎巫",因为放射科医生无意中发现了这些结构,并将其误解为险恶的病因。对于斜视外科医生来说,如果由于缺乏认识而漏诊了这些结构,尽管它们能产生复杂的斜视模式或具有自身的限制潜能,但未能识别它们可能会导致不利的手术结果。
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来源期刊
CiteScore
2.50
自引率
10.00%
发文量
322
审稿时长
3-8 weeks
期刊介绍: Ophthalmic Plastic and Reconstructive Surgery features original articles and reviews on topics such as ptosis, eyelid reconstruction, orbital diagnosis and surgery, lacrimal problems, and eyelid malposition. Update reports on diagnostic techniques, surgical equipment and instrumentation, and medical therapies are included, as well as detailed analyses of recent research findings and their clinical applications.
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