In my scrap sheet consisting of things that I-must-record-before-I-forget were above words.
What Dr.J went through with me during the surgery day on March 20th.
I remember from with my shameful response that I couldn't answer all the muscles in eyes innervated by which muscles (oculomotor muscle the obvious choice, but there are 2 other nerves that actually affect the eye movement, rather innervates muscles to the eyes moving it up, down, to sides and etc.)
Dr.J said in a teacher's tone, "Use the process of elimination. Everything is innervated by oculomotor nerve (CN 3) except lateral rectus muscle which abducts and thus innervated by abducens nerve (CN 6) and superior by trochelear (CN 4)." Actually I was able to say oculomotor after muttering to myself: ""Oh, oh, oh, to touch and feel very good velvet...ah, heaven."
That was very embarrassing and I didn't have a chance to redeem myself by compensating with the cool knowledge that I had - last time I mentioned SJS (I looked it up!) after blundering the basic concept to compensate my stupidity (to save thy face!).
The talk of extraocular muscle came after asking Dr.J about the recession surgery done on thyroid patients who has proptosis or exopthalmos. Typically with age, you have dermatochalasis and the two approach can be used to solve this problem. Blepharoplasty or ALR (anterior levator resection) surgery
See ALR surgery video here:
While the bleph surgery removes the fat and skin, ALR is the surgery for the muscle directly.
That is why patient have to practice "sit-ups" during the surgery to get the palpebral aperture right (so both eyes are symmetrical).
However, there's the exact opposite surgery which is called the recession surgery which reats the eyelid retraction - where the eyelids are abnormally wide (THYROID!).
Eyelid retraction recession weakens the muscle in the upper eye lid bring the eye lids down.
Anyway, for thyroid patients typically those with Grave's, their thyroid levels is up.
Thyroid level up -->
adrenergic up (that's why their heart beats very fast) -->
SNS activation (travel via carotid artery) -- Postganglionic sympathetic fibers originate in the superior cervical ganglion, and travel via the internal carotid plexus -->
muller's muscle activation (or superior tarsal muscle which is a smooth muscle adjoining the levator palpebrae superioris muscle that helps to raise the eye lid)-->
Proptosis!!
Tapazole and beta blockers are used to treat the grave's
and I have wrote alpha blockers too... interesting that Flomax which is a drug used to improve urination in men with benign prostatic hyperplasia.... is an alpha-blocker thus also treats high blood pressure.
I have to review medication yet again...used by patients and used during the surgery...
Moving on from Thyroid now, I would like to talk about Horner's and myasthenia gravis.
I don't know why but it is very difficult for me to differentiate between the two and I have also confessed this difficulty to Dr.J.
Both are manifested by ptosis.
With Horner's there's miosis (pupil smaller) and anhydrosis (no sweating)
With MG, acetycholine test and ice test.
I should know Horner's syndrome as my dad was suspected of having this due to possible tumors
Anyway, from Wikipedia:
Horner syndrome is due to a deficiency of sympathetic activity. The site of lesion to the sympathetic outflow is on the ipsilateral side of the symptoms. The following are examples of conditions that cause the clinical appearance of Horner's syndrome:
Myasthenia gravis (from Greek μύς "muscle", ἀσθένεια "weakness", and Latin: gravis "serious"; abbreviated MG) is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability. It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction
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