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Rare Congenital Anomaly of Orbicularis Oculi Muscle
VOL. 73, NO. 3
455
NOTES, CASES, INSTRUMENTS
R A R E C O N G E N I T A L ANOMALY O F ORBICULARIS OCULI MUSCLE L. C. DUTTA, F.R.C.S., AND H. U. AHMED, F.R.C.S. Gauhati, Assam, India
f
*
Congenital paresis, hypoplasia, and acces sory fasciculi of orbicularis oculi muscle are considered very rare congenital anomalies. The type of congenital anomaly of the orbic ularis oculi muscle seen in the case described here has not been reported before.
SA CASE REPORT
Fig. 4 (Romano). Modified lens as seen from below (from corneal aspect). SUMMARY
The Worst lens has a flange that fits be neath the eyelids and has four perforations for suture fixation to the globe. The flange is so large (20 mm in diameter) that it cannot be inserted in eyes with small palpebral fis sures, even after canthotomy. The flange can be reduced to 15 mm in its narrowest dimen sion by slicing off the flange on two opposite sides, between the perforations. This facili tates its insertion in such eyes while preserv ing the functions of the flange. ACKNOWLEDGMENTS
I express my appreciation to Mr. William Sowinski, of the House of Vision, Chicago, Illinois, for his assistance in carrying out this modification. The Worst prismatic goniotomy lens was obtained from Medical Instrument Research Associates, Boston, Massachusetts. REFERENCE
1. Worst, J. G. F. : The Pathogenesis of Congen ital Glaucoma. Assen, Van Gorcum, 1966, p. 101.
A 24-year-old Muslim man was seen at the sur gical out-patient department of Gauhati Medical College on September 16, 1970, because of a fleshy pendant mass suspended from the outer aspect of left orbital margin. It was apparently present since birth and was never painful, but it was gradually increasing in size. The patient did not recall any injury in relation to the mass. There was no consanguinity between his parents and no history of any congenital anomaly in any member of his family. His birth and delivery were normal. Physical examination revealed no other congenital abnormality. His eyes were normal in all respects. The mass was 7.5 cm in length and 3.25 cm in circumference at its base, gradually tapering to wards the tip. It was soft, freely movable, and cov ered with normal skin. At its base, the mass was connected to the orbital portion of the orbicularis oculi muscle, and when the patient squeezed his left eye, the mass reduced to one-fourth its original length and became erect with a puckered appearance of the surface. On September 19, 1970 the mass was excised un der local anesthesia. During surgery, it was found to have direct continuity with the interlacing fibers of the orbital raphe of the orbicularis oculi muscle. One artery and a pair of veins entered the mass at its base. Histopathologic examination showed that the skin covering the surface of the mass was normal skin, having hair follicles, sweat and sebacious glands. The central portion of the mass consisted of bands of longitudinal striated muscle fibers cut transversely. COMMENT
Shortening of the mass during squeezing was caused by contraction of the muscular From the Department of Ophthalmology and De partment of Surgery of Gauhati Medical College, India. Reprint request to Dr. L. C. Dutta, Silpukhuri, Gauhati, Assam, India.
456
AMERICAN JOURNAL OF OPHTHALMOLOGY
fibers. There was direct continuity of the fibers of orbicularis oculi muscle, and the histopathologic examination proved conclu sively that it originated from orbicularis oculi muscle. The orbicularis oculi muscle is a part of the facial musculature developed from the mesoderm of the second visceral arch. 1 From a developmental point of view, it is a special ized part of the platysma muscle and be comes separated from the parent muscle by the 16 mm stage in fetal life. During the process of growth, the fibers of upper and lower portions of the muscle decussate in a horizontal-lateral raphe, and at this site the deeper fibers are adhérant to the orbital sep tum. From these facts of developmental anatomy, it might be presumed that at the places of union of the two portions of eyelid developed from two embryonic segments (the upper eyelid from the frontonasal pro cess and the lower eyelid from the maxillary process), an aberrant growth of muscle
MARCH, 1972
fibers could occur which subsequently be came covered by skin. SUMMARY
A 24-year-old man had a fleshy, pedunculated mass 7.5 cm in length and 3.25 cm in circumference hanging from the outer aspect of the left orbital margin since birth. He had no other congenital defects. On squeezing of his left eye, the mass became shorter and erect, along with the contraction of orbicu laris oculi muscle. During its excision, its base was found to be intimately connected with the fibers of orbicularis oculi muscle, and histolopathologic examination showed it to be formed of striated muscle fibers. These findings suggest that the pendant mass was formed by aberrant growth of fibers of the orbicularis oculi muscle during the develop ment of the eyelids. REFERENCES
1. Duke-Elder, S.: System of Ophthalmology, vol. 3. London, Henry Kimpton, 1964, p. 236.
455
NOTES, CASES, INSTRUMENTS
R A R E C O N G E N I T A L ANOMALY O F ORBICULARIS OCULI MUSCLE L. C. DUTTA, F.R.C.S., AND H. U. AHMED, F.R.C.S. Gauhati, Assam, India
f
*
Congenital paresis, hypoplasia, and acces sory fasciculi of orbicularis oculi muscle are considered very rare congenital anomalies. The type of congenital anomaly of the orbic ularis oculi muscle seen in the case described here has not been reported before.
SA CASE REPORT
Fig. 4 (Romano). Modified lens as seen from below (from corneal aspect). SUMMARY
The Worst lens has a flange that fits be neath the eyelids and has four perforations for suture fixation to the globe. The flange is so large (20 mm in diameter) that it cannot be inserted in eyes with small palpebral fis sures, even after canthotomy. The flange can be reduced to 15 mm in its narrowest dimen sion by slicing off the flange on two opposite sides, between the perforations. This facili tates its insertion in such eyes while preserv ing the functions of the flange. ACKNOWLEDGMENTS
I express my appreciation to Mr. William Sowinski, of the House of Vision, Chicago, Illinois, for his assistance in carrying out this modification. The Worst prismatic goniotomy lens was obtained from Medical Instrument Research Associates, Boston, Massachusetts. REFERENCE
1. Worst, J. G. F. : The Pathogenesis of Congen ital Glaucoma. Assen, Van Gorcum, 1966, p. 101.
A 24-year-old Muslim man was seen at the sur gical out-patient department of Gauhati Medical College on September 16, 1970, because of a fleshy pendant mass suspended from the outer aspect of left orbital margin. It was apparently present since birth and was never painful, but it was gradually increasing in size. The patient did not recall any injury in relation to the mass. There was no consanguinity between his parents and no history of any congenital anomaly in any member of his family. His birth and delivery were normal. Physical examination revealed no other congenital abnormality. His eyes were normal in all respects. The mass was 7.5 cm in length and 3.25 cm in circumference at its base, gradually tapering to wards the tip. It was soft, freely movable, and cov ered with normal skin. At its base, the mass was connected to the orbital portion of the orbicularis oculi muscle, and when the patient squeezed his left eye, the mass reduced to one-fourth its original length and became erect with a puckered appearance of the surface. On September 19, 1970 the mass was excised un der local anesthesia. During surgery, it was found to have direct continuity with the interlacing fibers of the orbital raphe of the orbicularis oculi muscle. One artery and a pair of veins entered the mass at its base. Histopathologic examination showed that the skin covering the surface of the mass was normal skin, having hair follicles, sweat and sebacious glands. The central portion of the mass consisted of bands of longitudinal striated muscle fibers cut transversely. COMMENT
Shortening of the mass during squeezing was caused by contraction of the muscular From the Department of Ophthalmology and De partment of Surgery of Gauhati Medical College, India. Reprint request to Dr. L. C. Dutta, Silpukhuri, Gauhati, Assam, India.
456
AMERICAN JOURNAL OF OPHTHALMOLOGY
fibers. There was direct continuity of the fibers of orbicularis oculi muscle, and the histopathologic examination proved conclu sively that it originated from orbicularis oculi muscle. The orbicularis oculi muscle is a part of the facial musculature developed from the mesoderm of the second visceral arch. 1 From a developmental point of view, it is a special ized part of the platysma muscle and be comes separated from the parent muscle by the 16 mm stage in fetal life. During the process of growth, the fibers of upper and lower portions of the muscle decussate in a horizontal-lateral raphe, and at this site the deeper fibers are adhérant to the orbital sep tum. From these facts of developmental anatomy, it might be presumed that at the places of union of the two portions of eyelid developed from two embryonic segments (the upper eyelid from the frontonasal pro cess and the lower eyelid from the maxillary process), an aberrant growth of muscle
MARCH, 1972
fibers could occur which subsequently be came covered by skin. SUMMARY
A 24-year-old man had a fleshy, pedunculated mass 7.5 cm in length and 3.25 cm in circumference hanging from the outer aspect of the left orbital margin since birth. He had no other congenital defects. On squeezing of his left eye, the mass became shorter and erect, along with the contraction of orbicu laris oculi muscle. During its excision, its base was found to be intimately connected with the fibers of orbicularis oculi muscle, and histolopathologic examination showed it to be formed of striated muscle fibers. These findings suggest that the pendant mass was formed by aberrant growth of fibers of the orbicularis oculi muscle during the develop ment of the eyelids. REFERENCES
1. Duke-Elder, S.: System of Ophthalmology, vol. 3. London, Henry Kimpton, 1964, p. 236.