Purpose: To report a case of partial agenesis of the INFERIOR RECTUS muscle in a child who was presented because of ocular misalignment and a deficient depression of the right eye. Patient and findings: The patient was a 4-year-old girl. Preoperative CT scans confirmed the clinical diagnosis of INFERIOR RECTUS agenesis. The patient underwent augmented transposition of Horizontal recti muscles with good post-operative results.  Conclusion: Congenital absence of the INFERIOR RECTUS muscle is a possible cause of INFERIOR RECTUS muscle palsy. Although rare, agenesis deserves attention in the absence of another identifiable causes for INFERIOR RECTUS palsy. Muscle transposition procedures in conjunction with intramuscular botulinium toxin injection or other weakening procedures of the superior RECTUS muscle have had appreciable functional and cosmetic results in these patients.

Background: Abdominoperineal resection (APR) is the standard surgical treatment for low-lying anorectal malignancies. It seems that immediate flap reconstruction has fewer complications compared to primary closure. There are several options for local flap reconstruction of perineal wound closure, and each specific flap method has its own advantages and disadvantages. Case presentation: In this case report, a new method of reconstruction is presented which contains only the INFERIOR part of the RECTUS abdominis muscle in 2 patients, one with unilateral and the other with bilateral involvement and they both underwent APR. Both patients were referred to the colorectal surgery clinic for APR by an oncologist. Both patients had severe constipation and both reported pain on defecation and rectorrhagia. Patient 1 received a unilateral INFERIOR part of RECTUS abdominis muscle flap and patient 2 received a bilateral flap. Conclusion: Immediate flap reconstruction after APR has fewer complications than primary closure and the INFERIOR part of RECTUS abdominis muscle flap seems to be a possible means of reconstruction after APR.

Purpose: To compare the results of lateral RECTUS resection and medial RECTUS rerecession on the patients with residual esotropia at Emam Hossein Medical Center, since2004 to 2005. Patients &Methods: This double blind controlled clinical trial study was performed on 25 patients with residual esotropia by consecutive selection. After signing of consent form by the patients or their parents, cyclorefraction, best corrected visual acuity, deviation, near point of convergence, medial RECTUS function were measured by our orthoptist. On table of operation, if FDT was positive, MR ReRec. and if it was negative, both methods were done by random selection. 12 patients were operated with rerecession of medial RECTUS (cases) and 13 patients were operated with lateral RECTUS resection (controls). Patients were re-examined-after 1.5 months follow up by the same orthoptist who did not know the type of operation. The results were analysed by T, Fisher exact and X2 tests. Results: 15 (60%) of patients were female and 10 (40%) were male. The patients were matched as their spherical equivalent; best corrected visual acuity, degree of deviation and near point of convergence. The success rate of the case and control groups were 67% and 54% respectively, but the difference was not statistically significant. Each millimeter of MR ReRec. has corrected 7.5 pd and each millimeter of LR Res. Has corrected 2.5 pd of residual esotropia. Medial RECTUS mild underaction were seen in 50% of cases, but only 17.5% of them showed increased near point of convergence. There were no muscle slippage or lost, exotropia and scleral perforation. Conclusion: Considering the results of this study, lateral RECTUS resection can be substituted with medial RECTUS rerecession in special situations. Medial RECTUS underaction was relatively mild and would not produce cosmetic problem.    

BACKGROUND The standard surgical treatment for low rectal cancer is abdominoperineal resection (APR). Comparing to primary closure, immediate flap reconstruction has shown to have good outcomes. We aimed to assess the INFERIOR RECTUS abdominis muscle flap complications after APR surgery, a new method of reconstruction. METHODS This study was conducted from 2014 to 2016 in a single center in Firoozgar Hospital, Tehran, Iran. Eighteen patients who underwent pelvic floor closure with INFERIOR part of abdominis RECTUS musculofascial flap were included enrolled. The sampling method used in this study was census. All patients had distal rectoanal malignancies. A checklist including age, gender, tumor location, complications after surgery, tumor type, length of hospital stay, length of operation, neoadjuvant chemotherapy and neoadjuvant radiotherapy history was filled for all patients. RESULTS Among 18 participants, 27. 8% were female. The mean age of participants was 58. 28 ±,17. 86 yr (minimum of 19 and the maximum of 89 yr). The pathology of the tumor in all but one of the cases was adenocarcinoma (94. 4%). The overall complication rate after surgery was 27. 8%. In total, 80% received neoadjuvant chemoradiotherapy. In 12 months follow-up 2 patients needed reoperation. CONCLUSION INFERIOR part of RECTUS abdominis muscle flap was a reliable and comparable means of reconstruction after APR surgery with low rate of complications and mortality.

Purpose: To report the result of strabismus surgery in a case of INFERIOR RECTUS aplasia with a relatively small amount of hypertropia. Case Report: A 22-year-old man was referred to the strabismus clinic for evaluation of an abnormal head posture and right eye deviation. Eyes exam revealed a best-corrected visual acuity of 10/10 in both eyes; the patient had a right head tilt along with a right hypertropia and exotropia. The hypertropia measured 14 PD in the primary gaze position and increased during the right gaze and left head tilt. The exotropia had an Apattern. Ocular motility revealed downgaze limitation of the right eye in the abduction; however, in straight downgaze, the right eye passed the midline with a moderate overaction of the left superior oblique muscle. Based on the initial clinical findings, a diagnosis of right INFERIOR RECTUS palsy was made. Intraoperatively, a positive force duction test indicating superior RECTUS restriction was noted; therefore, we planned to perform a right superior RECTUS recession along with a right INFERIOR RECTUS resection. However, after recessing the right superior RECTUS, we were surprised to find that the IR muscle was not present, and there were only a few strands of fibrovascular tissue in that region. We changed our surgical plan and performed transposition of INFERIOR oblique muscle to the expected site of insertion of aplastic IR muscle 6. 5 mm from the limbus after a 6 mm resection. After surgery, the absence of IR muscle was confirmed by an orbital CT scan (Figure 2). Post-operatively, the patient’ s eyes were orthophoric in the primary position, and his abnormal head posture was significantly improved. The exam findings remained stable until his last visit at the sixth postoperative month. Conclusion: INFERIOR RECTUS aplasia should be kept in mind as a differential diagnosis of congenital INFERIOR RECTUS muscle paresis/palsy. This condition may manifest with a modest amount of hypertropia in the primary position, and the ipsilateral superior oblique muscle may be over-active, thus generating enough force to move the eye downward past the midline. Orbital imaging is the only way to arrive at a definitive diagnosis preoperatively.

Purpose: To report a case of intraoperative rupture of INFERIOR RECTUS muscle, which was retrieved and later successfully transposed for management of sixth nerve palsy. Methods: Case report. Results: A 36-year-old woman presented with traumatic right sixth nerve palsy and esotropia following a car accident five years earlier. During the originally planned vertical transposition surgery, the INFERIOR RECTUS muscle snapped, but was retrieved and resutured to the sclera 3 mm posterior to the original insertion. After a few months, the second attempt of transposition of vertical recti (including the previously snapped and reattached INFERIOR RECTUS) was successful, and the patient achieved satisfactory postoperative alignment. Conclusions: Intraoperative rupture of an extraocular muscles is a rare and serious complication encountered during strabismus surgery. However, if successfully retrieved, this muscle has still the chance of future re-operation.