M. obliquus-inferior-Nekrose mit Rekonstruktion bei intraorbitalem Holzfremdkörper
BACKGROUND Injuries of an extraocular muscle or of the globe due to a dog-bite are rare. PATIENT An 43-year-old patient presented with an orbital dog bite. He had a complete avulsion of the inferior rectus muscle. During the primary surgical repair, the proximal part of the muscle could not be found. The distal part of the inferior rectus muscle was sutured to the tissue in the original region of the retracted inferior rectus muscle. After surgical repair the patient could read without complaint. We explain the unexpected remarkable postoperative result on the basis of high resolution MRI: Although the muscle belly was lost, some parts of the muscle sheath forming connections to Tenon's capsule had remained. These allowed a certain function of the muscle. CONCLUSIONS If during the primary surgical repair of a traumatic avulsion of an extraocular muscle the proximal part of the muscle could not be found, it is worth to suture the distal part of the muscle to tissues (empty muscle sheath, connections to Tenon's capsule) in the original region of the lost muscle. This prevents a further retraction of the proximal part of the muscle and helps the finding and differentiation of the structures of the muscle during a prospectivly following surgical repair.