Palmaris longus tendon as an autogenous expander for Brown's syndrome: A novel technique

Superior oblique tendon expansion with Achilles tendon allograft for treating Brown syndrome

“…In addition, we avoided an expander longer than 8 mm to diminish the possibility of secondary superior oblique palsy. 2 Overall, 4 eyes showed acceptable outcomes while 1 eye partially improved probably due to technical problems and/or severing of the inner layer of the nasal intermuscular septum. We did not explore the involved eye to detect the exact cause.…”

“…14 Recently, some biologic spacers such as autologous fascia lata and palmaris longus tendon have been used for superior oblique muscle elongation with favorable short-term outcomes. 2,14 However, autograft tendons may be of unreliable length, thickness, strength, and integrity. 15 In addition, the use of autografts can be very technically challenging and time-consuming and can add to the potential risks of donor-site morbidity or cosmetic impact of multiple scars.…”

“…Restriction of elevation in adduction was graded as À1 (mild) to À4 (most severe). 2 Residual hypotropia in the primary position, residual deviations in adduction, and limitation of upward gaze in adduction (as revealed by forced duction test) were regarded as outcome measures. Any complications, such as rejection, superior oblique palsy, inflammation, extrusion, or infection, were also recorded.…”

“…2,3 Observation remains the most common form of management for the mild and moderate forms of Brown syndrome. Several surgical procedures have been introduced for management of the most severe cases.…”