[Surgical treatment of third cranial nerve palsy]

To study surgical treatment results of third cranial nerve palsy.

We have retrospectively studied 11 patients with a third cranial nerve palsy (10 unilateral and 1 bilateral) who were subjected to surgery. The etiology was traumatic in 4 cases, congenital in 2, vascular in 4, and tumoral in 1. Torticollis was present in 7 patients and 5 had diplopia. A good aesthetic result was defined by a final deviation of less than 10 prismatic diopters, a medium result by a deviation between 10-20 diopters and a bad result if the deviation was > or = 20 diopters. A good functional result was considered if there was no diplopia when the eyes were in their primary position.

In all instances large recessions and/or resections of horizontal recti muscles were performed. Vertical deviation was treated in 4 cases. Multiple surgery was needed in 3 cases, 2 patients being operated on twice and 1 case was operated on four times. Botulinum toxin was used in 4 cases, before or after surgery. The aesthetic result was good in 7 cases, medium in 2, and bad in the other 2. Postoperative diplopia was present in 4 cases. Mean postoperative follow-up was 27.9 months.

Large recti muscle recessions and resections are our first surgical technique to treat problems of third cranial nerve palsy. Sometimes several surgeries are required to treat vertical deviation and previous hypocorrection. Botulinum toxin is a complementary treatment. Functional results are worse than aesthetic ones.