Surgical Treatment of Fourth Cranial Nerve Palsy

Purpose: To comparatively evaluate the effects of different surgical techniques on vertical deviation in various clinical types of 4th cranial nerve palsy. Material and Method: We evaluated prospectively thirty-two patients who attended to Strabismus Unit of Ophthalmology Department, Cerrahpasa Medical Faculty with superior oblique palsy (SOP) between September 2007 and May 2009. The cases were divided into 4 groups according to the type of surgery performed: group 1 (n= 12) anterior transposition of the inferior oblique muscle for + 3 inferior oblique overaction (IOOA); group 2 (n= 9) inferior oblique recession for + 1 and + 2 IOOA; group 3 (n= 6) inferior oblique myectomy for + 4 IOOA; group 4 (n= 5) superior oblique tucking in cases which exhibited superior oblique hypofunction and loose superior oblique tendon without IOOA. The patients were examined pre-operatively and on the 1st day, at 1 week and at 1, 3 and 6 months post-operatively. The amount of squint (prism diopter) was measured. Results: Seventeen patients (53.1%) were male and 15 (46.9%) were female with a mean age of 16.41+/-11.91 years. Twenty-four cases of SOP (75%) were congenital and 8 (25%) were acquired. The mean decrease in vertical deviation in primary position post-operatively was found statistically significant in all groups. Discussion: A single surgery of inferior or superior oblique muscle was found to be effective and the first-choice treatment for SOP when the indication was given properly.