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Inicio Archivos de la Sociedad Española de Oftalmología (English Edition) Nishida procedure associated with botulinum toxin in a long-standing complete bi...
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Vol. 94. Issue 10.
Pages 500-503 (October 2019)
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Vol. 94. Issue 10.
Pages 500-503 (October 2019)
Short communication
Nishida procedure associated with botulinum toxin in a long-standing complete bilateral sixth cranial nerve palsy
Procedimiento de Nishida asociado a toxina botulínica en parálisis completa del sexto par craneal bilateral de larga evolución
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L. Mata Moret
Corresponding author
luciamatamoret@gmail.com

Corresponding author.
, R. Freiria Barreiro, E. Cervera Taulet, C. Monferrer Adsuara, M. Ortiz Salvador, P. Palomares Fort
Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Abstract

In severe cases of abducens or sixth cranial nerve palsy, transpositions of the superior rectus and inferior rectus into the paralytic lateral rectus have been demonstrated to be useful. Numerous techniques have been described over time to carry out these transpositions, such as the Hummelscheim, O’connor, Jensen, Foster, or Nishida technique. The first 4 techniques mentioned above have an increased risk of anterior segment ischaemia.

The case is presented of a long-standing bilateral sixth cranial nerve palsy secondary to a severe cranial injury. Given the risk of ischaemia of the anterior segment, the Nishida technique was chosen in order to reduce the risk of suffering from this complication. This is combined with botulinum toxin in both middle rectus to try to resolve the muscle contracture associated with the long evolution of the case, obtaining good results at 6, and 12 months after the surgical procedure.

Keywords:
Sixth cranial nerve palsy
Rectus transposition
Anterior segment ischaemia syndrome
Nishida procedure
Resumen

En los casos severos de parálisis del abducens o sexto par craneal resultan útiles las transposiciones de rectos superiores (RS) y rectos inferiores (RI) hacia el recto lateral (RL) paralítico. Se han descrito numerosas técnicas a lo largo del tiempo para la realización de estas transposiciones como son la técnica de Hummelscheim, O’connor, Jensen, Foster o Nishida. Las 4 primeras técnicas anteriormente citadas, llevan aparejado un aumento del riesgo de isquemia del segmento anterior.

Presentamos el caso de una parálisis de sexto par craneal bilateral de larga data de evolución secundaria a un traumatismo craneo encefálico severo (TCE). Para minimizar el riesgo de isquemia del segmento anterior se optó por la realización de la técnica de Nishida, asociado a botox en ambos rectos medios (RM) para tratar de resolver la contractura muscular asociada a la larga evolución del caso, obteniendo buenos resultados a los 6, y 12 meses tras el procedimiento quirúrgico.

Palabras clave:
Parálisis del sexto par craneal
Transposición de rectos
Síndrome de isquemia del segmento anterior
Procedimiento de nishida

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