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Myasthenia gravis is a neuromuscular disease of insidious onset, characterized by weakness and fatigability of voluntary muscles. Most patients present with symptoms relating to the head and neck and thus may be seen first by the otolaryngologist. Predominant symptoms may be ocular (ptosis or diplopia) or related to fatigue of the oropharyngeal or laryngeal musculature (dysarthria, dysphonia, or dysphagia). Alleviation of muscular weakness and fatigability after administration of anticholinesterase drugs is pathognomonic of myasthenia gravis.
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PMID:The otolaryngologic presentation of myasthenia gravis. 44 37

Cartilaginous tumors arising from the skull or intracranial structures are infrequently seen. There have been 112 such cases reported. They are most commonly found in the middle fossa and the parasellar region. They arise from cartilaginous rests in the base of the skull, particularly around the basal synchondroses. Occasional cases of intracranial growths also show lesions in peripheral bones. The authors have encountered a case in which chondroma was a manifestation of generalized chondromatosis. The patient was a 25-year-old male, who complained of diplopia in May 1975. He noted ptosis in his left eyelid which gradually progressed over a 2 months period to complete ptosis. When he was admitted in July 1975 to Nagoya National Hospital, the neurologic signs revealed a palsy of the IIIrd cranial nerve on the left side. The patient has been suffering from generalized enchondromatosis during a period of 20 years. Roentgenograms revealed extensive areas of bone destruction and pathological calcification of the phalanx, ribs, hip bone, femur, tibia, ulna and radius. Roentgenograms of the skull revealed calcification on the left middle fossa. After a left carotid angiography, an osteoplastic craniotomy was performed on August 5, 1975. The tumor was located in the extradural space of the middle cranial fossa. After incision of the capsule, gelatinous semisolid tissue was removed piecemeal. Its total removal proved to be impossible. Histological examination of this tumor revealed enchondroma.
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PMID:[A case of enchondroma of the skull base--a manifestation of generalized chondromatosis (author's transl)]. 55 59

Following severe trauma to the middle third of the face, a common deformity requiring secondary correction is a combination of lowered orbital floor and enophthalmos often associated with diplopia and ptosis. Silicone discs are used to elevate the orbital floor and silicone beads inserted subperiosteally to correct the enophthalmos. In a series of 44 cases we have had no instance of infection or rejection although some beads had to be removed in 1 patient because of increased pressure on the eye. Close collaboration between plastic and ophthalmic surgeons is essential.
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PMID:Silicone sheet and bead implants to correct the deformities of inadequately healed orbital fractures. 67 28

To minimize the risk of visual loss in diabetic patients, recognition of early signs of oculopathy is essential. Diabetes-associated third-nerve palsy is manifested by unilateral ptosis and exotropia. Symptoms of closed-angle glaucoma are intense pain, halos around lights, and blurred vision. Open-angle glaucoma does not necessarily produce symptoms and is treated medically. A gradual decrease in visual acuity, sometimes associated with photophobia and difficulty in night driving, and monocular diplopia, are manifestations of cataract. The patient with "background" retinopathy usually complains of blurred or distorted central vision. Once the macula is involved, vision progressively decreases. Although the relationship of metabolic control to retinopathy has not been settled, evidence indicates that good medical control of the disease may delay onset of vascular complications.
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PMID:Four common ocular complications of diabetes--and how to treat them. 71 Aug 91

A 59-year-old woman has been treated for 5 months with penicillamine for a rheumatoid arthritis and developed a myasthenia syndrome with ptosis, diplopia, dysphagia and asthenia. This myasthenia was slowly cured after suppression of the penicillamine and administration of Mestinon, so that after 3 months, the anticholinesterase medication could be stopped.
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PMID:[Myasthenia syndrome after peroral treatment with penicillamine]. 74 27

The charts of 324 patients treated for 363 orbital floor fractures between 1965 and 1973 were reviewed retrospectively. Of these, 38 (11 percent) were isolated floor fractures, 27 (8 percent) were rim and floor fractures, 168 (46 percent) were trimalar fractures and 130 (35 percent) were associated with complex facial fractures. On initial examination, 31 percent of the patients were found to have diplopia and 4 percent enophthalmos. Orbital prolapse was suspected in 31 percent of the patients. Thirty-seven percent of the patients had demonstrable ocular injury at the time of initial examination. Treatment was surgical in 336 of the fractures and non-surgical in 29. Of the surgical patients 140 had no support placed, 120 had antral support only, 51 had both antral support and orbital implant, and 20 had an orbital implant only. Postoperatively the incidence of diplopia was 8 percent in all patients, and 7 percent had enophthalmos. A smaller group followed for more than five months, were found to have diplopia in 17 percent and enophthalmos in 11 percent. Of the 29 patients treated non-surgically, none had persistent diplopia.
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PMID:Fractures of the orbital floor. 86 8

A retrospective series of 365 orbital floor fractures was studied and many variables were analyzed. Some type of ocular or orbital adnexal damage was present in 32% of the patients. After a repair procedure there was a low incidence of decreased visual acuity, and there were no implant extrusions. Late enophthalmost and diplopia were found to be related to the type of orbital floor damage. The comminuted floor fractures and fractures associated with prolapse of orbital tissue into the maxillary antrum were more prone to demonstrate these late sequelae. Despite various surgical procedures there was a 19% incidence of late diplopia and an 11% incidence of late enophthalmos.
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PMID:Oribital floor fractures: a retrospective study. 97 Aug 55

After a severe trauma of the face, e.g. fractures involving the zygoma, the upper jaw or other orbital bone alteraions and deviations of the bony orbital contours and also of the orbital contents can subsist, even after primary operative correction. The patients have functional as well as cosmetic complaints. In consequence of eyeball dislocation and incarceration or fibrosis of the external eye muscles, the patients also complain of diplopia in one or more directions. Due to the bony orbit enlargement and reduction of the orbtial contents, the eye is moved inferiorly and backwards, also causing diplopia, ptosis and a deep sulcus of the upper lid. The treatment consists in closing and sufficient raising of the orbital floor correction of the enophthalmos. To cover the floor fracture, we apply 1-8 perforated Teflon implants which are placed under the periost of the orbital floor. To correct the enophthalmos, we use 30-50 Teflon beads with a diameter of 5 mm, and placed them in a sub-periorbital pocket laterally above and behind the eyeball, thus ensuring that the eye will be forced forwards in the cone-shaped orbit and so diminish or eliminate the enophthalmos. The operation is performed in close cooperation between an ophthalmologist and a plastic surgeon. Most of our cases also needed operative muscle correction. Although not all deviations could be totally corrected, we always achieved a clear improvement, and all 36 patients obtained a useful field of binocular single view. Until now we have had no implant infections or rejections. We should like to consider that this method of correction will have its own place in the treatment of orbital deformities.
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PMID:Orbital corrections with the use of alloplastic material. 117 36

Since Fincher reported a case with arteriovenous fistula between the external carotid artery and dural sinus, many type of cases have been reported. On the other hand, so called the external carotid avernous fistula has been recognized less 20 cases in literature. We have observed three additional cases of dural arteriovenous shunts in the region of the cavernous sinus. Case 1. A 52 year old woman had suffered from left side sever headache. There was weakness of the left extraocular muscles and left ptosis. A bruit was heard over the left orbit. She was treated for hypertension since 38 year old. And she has no history of recent trauma. Selective internal and external carotid angiographies showed the bilateral external carotid cavernous sinus fistula. No operative treatment was performed in this case and the symptomes disappeared with decrease of blood pressure. Case 2. A 50 year old man came to this clinic with chief complaints of right ptosis, diplopia and headache. He was treated for diabetes mellitus and hypertension for six month...
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PMID:[Three cases of spontaneous bilateral external carotid-cavernous sinus fistula (dural arteriovenous shunts in the region of the cavernous sinus) (author's transl)]. 123 13

Lung function and clinical evidence of muscle weakness were assessed in 12 ASA I patients who received vecuronium 0.01 mg kg-1 pretreatment as a part of their anaesthetic management, before and 3 min after pretreatment. Most patients demonstrated ptosis and diplopia, while five of the 12 were unable to raise the head for > 4 s and had difficulty in swallowing. Significant reductions occurred in forced vital capacity, forced expiratory volume in 1 s, and maximum mid-expiratory flow rate. Among static lung volumes, functional residual capacity and expiratory reserve volume decreased significantly. However, these changes were not serious enough to cause clinically significant impairment of coughing or a decrease in oxygen saturation in any patient.
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PMID:Lung function after vecuronium pretreatment in young, healthy patients. 135


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