Orbital wall approach with preoperative orbital imaging for identificationand retrieval of lost or transected extraocular muscles

Purpose:To report the results of an anterior approach along the orbital wal l to recover a lost or transected extraocular muscle. Methods: This is a re trospective review of lost or transected muscles retrieved by an anterior o rbitotomy approach to the adjacent orbital wall because they were unable to be recovered by a standard conjunctival approach. Magnetic resonance imagi ng or computed tomography was performed on all subjects before surgery. Res ults. Six patients underwent anterior orbitotomy via an orbital wall approa ch; all had undergone an attempted retrieval from a standard transconjuncti val approach that failed. Five muscles had been lost from surgical or traum atic transection, and 1 muscle had been lost during strabismus surgery. The muscle location at retrieval ranged from 20 to 25 mm (mean, 23 mm) posteri or to the limbus. The duration that these muscles were disinserted ranged f rom 7 days to 7.5 years (mean, 24 months). Preoperative deviation in primar y gaze ranged from 15 to 50 PD, whereas first day postretrieval deviations all measured less than 8 PD. After a mean follow-up of 162 weeks, the mean deviation in primary gaze was 2 PD (range, orthotropia to 7 PD of esotropia ). Conclusions: Anterior orbitotomy along the orbital wail with preoperativ e orbital imaging of extraocular muscle anatomy and function combine to cre ate a valuable approach for retrieval of a lost or transected muscle. This technique may successfully retrieve lost or transected muscles that previou sly were irretrievable when using a standard transconjunctival approach.