眼窩蜂巣炎に上斜筋麻痺が合併した小児の1例

Superior oblique palsy as a complication of orbital cellulitis in a child

（P−1-21）　4歳男児に高熱，両眼瞼腫脹，両眼痛が突発し，その翌日に受診した。右眼瞼に重度，左眼瞼に軽度の腫脹があった。MRI検査で両側の眼窩にびまん性の膿瘍が同定された。急性副鼻腔炎に続発した眼窩蜂巣炎と診断し，抗生物質の全身投与を開始した。その6日後に斜頸と複視が生じ，右上斜筋麻痺と診断した。以後の経過は良好であり，斜頸と複視はさらに3週後に消失した。上斜筋単独麻痺は，齢骨洞の炎症が眼窩内側壁を通じて浸潤し，総腱輪の外側で滑車神経を圧迫した結果であると推定した。

A 4-year-old male child developed acute fever with lid swelling and pain in both eyes. When seen the following day, severe swelling was present in the right eyelid and moderate swelling in the left. Magnetic resonance imaging showed diffuse abscess in both orbits. He was treated by systemic antibiotics under the diagnosis of orbital cellulitis secondary to acute parasinusitis. He developed torticollis and diplopia 6 days later. Tha condition was diagnosed as right oblique palsy. Spontaneous recovery took place and diplopia disappeared 3 weeks later. The oblique palsy appeared to have been induced by ethmoidal sinusitis which infiltrated through the medial orbital wall suppressing the trochlear nerve lateral to the common annular ligament.