Afilamiento del oblicuo superior en el síndrome de Brown «Plus». Resultados.

espanolObjetivo: Estudiar los resultados obtenidos en los pacientes con sindrome de Brown congenito intervenidos mediante la tecnica del afilamiento del oblicuo superior. Metodo: De los 19 casos diagnosticados de sindrome de Brown en nuestra seccion durante un periodo de 4 anos (enero de 1992 y diciembre de 1995), 9 enfermos fueron seleccionados e intervenidos por presentar hipotropia en posicion primaria de la mirada y/o torticolis. En 3 casos se asocio una retroinserccion del oblicuo superior. Resultados: La limitacion de la elevacion en aduccion mejoro en todos los casos excepto en uno (11,1%). La hipotropia prequirurgica presente en 7 enfermos (77,8%) se resolvio posteriormente en 5 (71,42%). El torticolis inicial con una incidencia del 77,8% (7/9) desaparecio por completo en 3, y mejoro en otros 3. La vision binocular se recupero en 2 casos. Un mal resultado se obtuvo en un 22,22% (2/9) por persistir el torticolis y la hipotropia. No se observaron complicaciones intraoperatorias ni postoperatorias, salvo una paresia transitoria del oblicuo superior que no requirio cirugia. Conclusiones: El afilamiento del tendon del oblicuo superior es una tecnica eficaz en el tratamiento del sindrome de Brown en aquellos pacientes que presentan una alteracion vertical en posicion primaria de la mirada y/o torticolis. EnglishPurpose: To study the results found in patients with congenital and constant Brown’s Syndrome who were surgically treated with superior oblique sharpening technique. Method: Nine patients were selected among nineteen cases diagnosed of Brown’s Syndrome in our Department for 4 years. Indications for surgery were vertical deviation in primary position and/or torticollis. The procedure of choice was the superior oblique sharpening in all cases, associated to its recession in 3 patients. Results: The limitation of elevation in adduction was notably marked in 100% of the cases, improving in all of them, except in one patient (11.1%) after surgery. The preoperative hypotropia presented in 7 cases (77.8%) was resolved in 5 (71.42%) after the intervention. The initial torticollis had the same incidence than the hypotropia (77.8%: 7/9), but it completely resolved in 3 cases, and improved in 3 other with this technique. Binocular vision was recovered in 2 patients. Overall, 2 out of the 9 cases (22.22%) did not clinically improve. Intraoperative and postoperative complications were not observed, except a temporary superior oblique palsy that resolved without surgery. Conclusions: The superior oblique sharpening is a good technique which may improve the Brown Syndrome patients with primary position deviation and/or torticollis.