Dynamic reanimation of severe blepharoptosis using the neurotized omohyoid muscle graft.

BACKGROUND: Attempts at dynamic reconstruction of the upper eyelid either by neurotization or direct muscle replacement have been scarce. Substitution of the levator palpebrae superioris muscle requires the use of extremely small and pliable structures. As a proof of concept/pilot study, we present a consecutive series of patients who underwent blepharoptosis correction using the neurotized omohyoid muscle graft. METHODS: Retrospective analysis of patients receiving a neurotized omohyoid muscle graft for levator palpebralis substitution between January and December 2019. RESULTS: Five patients were operated (2 male, 3 female); median age was 35.5 years. Median palpebral aperture was 0 mm and levator function was< 1 mm in all cases. Median denervation time for the levator muscle was 9 years. All surgeries were uneventful, and no postoperative complications were seen. Twelve months after the procedure, all patients presented with adequate palpebral aperture on activation of the spinal nerve. Median palpebral aperture was 6.5 mm Postoperative electromyography revealed muscle contraction when stimulation was applied to the spinal nerve. CONCLUSION: This study introduces the concept of severe blepharoptosis correction using the omohyoid muscle. We believe that with time and further technical refinements it could become an invaluable tool in eyelid reconstruction surgery.

[Traumatic arteriovenous pial fistula masquerading as a carotid-cavernous fistula: an uncommon disorder with an unusual presentation]. / Fístula arteriovenosa pial traumática que simula una fístula carotidocavernosa: una enfermedad infrecuente con una presentación excepcional.

Traumatic intracranial pial arteriovenous fistulae are infrequent lesions. Their cardinal signs have been related to mass effect and hemorrhage, but their clinical manifestations due to venous retrograde flow into ophthalmic veins has never been described. This phenomenon is usually seen in dural arteriovenous fistula draining to the cavernous sinus or carotid-cavernous sinus fistula.A traumatic intracranial pial arteriovenous fistula arising from the supraclinoid internal carotid artery in a young patient was revealed by aggressive behavior and ophthalmologic manifestations. The endovascular management included the use of coils, stent, and ethylene-vinyl alcohol with transient balloon occlusion of the parent vessel.