A case of acquired Brown syndrome after surgical repair of a medial orbital wall fracture

A Rare Case of Cyclotorsion Due to Medial Rectus Displacement Following Orbital Trauma

We describe a rare case of cyclotorsion likely secondary to medial rectus and inferior rectus pathology in a patient with orbital trauma. Sequential orthoptic measurements including Hess charts are presented alongside relevant sections of the orbital CT scans over the course of the patient’s treatment. Following the insertion of a plate to repair an orbital floor fracture, the patient developed cyclotorsion. A combined approach of sequential orthoptic assessment and imaging revealed the likely underlying mechanism. Inferior rectus mechanical restriction combined with displacement of the medial rectus pulley appear to be the likely culprits. Once the orbital plate was exchanged for a smaller sized plate the patient’s symptoms and clinical features resolved. Although orbital plate malpositioning is not an uncommon event, medial rectus deviation as a cause of cyclotorsion has not previously been described. We discuss the alternative differentials for patients with similar orthoptic findings and how they were excluded.

Post-traumatic superior oblique tendon nodule associated with acquired Brown syndrome

A 67-year-old woman presented with a left hypotropia and eye pain after a traumatic fall. She had multiple left orbital wall fractures and an acquired limitation to elevation in all gazes, worse in adduction, suggestive of Brown syndrome. During strabismus surgery, a white nodule on the superior oblique tendon was identified and excised. Histopathology of the nodule revealed densely aggregated inflamed fibrovascular and fibrocollagenous scar tissue. Superior oblique rupture with spontaneous reparative reapproximation resulting in nodular formation is uncommon. We speculate that resulting tendon shortening may have contributed to the apparent Brown syndrome in this patient.

Three cases of acquired simulated brown syndrome after blowout fracture operations

Brown syndrome is known as limited elevation of the affected eye during adduction. It is caused by a disorder of the superior oblique tendon, which makes it difficult for the eyeball to look upward, especially during adduction. It is classified into congenital true sheath Brown syndrome and acquired simulated Brown syndrome. Acquired simulated Brown syndrome can be caused by trauma, infection, or inflammatory conditions. The surgical restoration of blowout fractures can also lead to limitations of ocular motility, including Brown syndrome. We report on three patients with acquired simulated Brown syndrome, who complained of diplopia and limitation of ocular motility after operations to treat blowout fractures.

Management of fractures of the nasofrontal complex

Repair of fractures involving the nasofrontal region remains a mainstay of contemporary oral and maxillofacial surgery. This article discusses the epidemiology of these injuries, anatomy of the area, and management of these fractures with insight into potential complications. These include fractures of the frontal sinus, naso-orbital-ethmoidal region, root of the nose, and associated adjacent structures.

Superior oblique muscle entrapment in orbital fracture presenting as acquired brown-like syndrome: a case report and review of literature

Pediatric orbital trauma with fracture involving the junction of roof and medial wall leading to superior oblique entrapment is rare. Here the authors report a case of orbital fracture at the junction of roof and medial wall with entrapment of the superior oblique muscle presenting clinically as canine tooth syndrome which was surgically released. Postoperatively, the ocular motility improved, and the patient was relieved of diplopia. They recommend early surgical exploration in such cases, which lead to successful resolution of diplopia.