Retrieval of lot medial rectu mucle with a combined ophthalmologic and otolaryngologic urgical approach

PURPOE: To report retrieval of a medial rectu mucle completely detached from the globe and lot in the orbital tiue in four eye. METHOD: A lot medial rectu mucle wa retrieved in four eye of four patient with either a trancutaneou medial orbitotomy approach or a trannaal endocopic ethmoid inu approach. REULT: The lot medial rectu mucle wa uccefully retrieved in all four patient. One patient lot the medial rectu mucle econdary to trauma, and the other three cae reulted from complication of trabimu urgery. The mean preoperative angle of exotropia wa 44 prim diopter. The endocopic approach wa attempted in three patient, and the medial rectu mucle wa uccefully found in two of thee patient. In one cae in which the endocopic approach wa ued, an image guidance ytem wa ued to aid in finding the lot medial rectu mucle. The endocopic approach wa abandoned in one cae in which the medial rectu mucle could not be identified after extenive earching, but the mucle wa ubequently found by mean of the trancutaneou medial orbitotomy approach. A trancutaneou medial orbitotomy alone wa ued to find the lot medial rectu mucle in one of the cae. The potoperative ocular deviation for primary poition at ditance fixation wa a mean of 24 prim diopter of exotropia. With one additional operation in two patient, the mean ocular deviation wa le than 12 prim diopter. CONCLUION: We uccefully retrieved a lot medial rectu mucle in four patient with the ue of nontraditional trabimu urgical technique. We effectively combined technique taken from both ophthalmology and otorhinolaryngology to help olve thi difficult problem.