open access

Vol 79, No 3 (2020)
ORIGINAL ARTICLES
Published online: 2019-10-16
Submitted: 2019-09-20
Accepted: 2019-10-12
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Morphometric study of the ciliary ganglion and its pertinent intraorbital procedure

L. Tesapirat, S. Jariyakosol, V. Chentanez
DOI: 10.5603/FM.a2019.0112
·
Pubmed: 31621056
·
Folia Morphol 2020;79(3):438-444.

open access

Vol 79, No 3 (2020)
ORIGINAL ARTICLES
Published online: 2019-10-16
Submitted: 2019-09-20
Accepted: 2019-10-12

Abstract

Background: Ciliary ganglion (CG) can be easily injured without notice in many intraorbital procedures. Surgical procedures approaching the lateral side of the orbit are at risk of CG injury which results in transient mydriasis and tonic pupil. This study aims to focus on the morphometric study of the CG which is pertinent to intraoperative procedure.

Materials and methods: Forty embalmed cadaveric globes were dissected to observe the location, shape and size of CG, characteristics and number of roots reaching CG, number of short ciliary nerve in the orbit. Distances from CG to posterior end of globe, optic nerve, lateral rectus muscle and its scleral insertion were measured.

Results: Ciliary ganglion was located between optic nerve and lateral rectus in every case. Its shape could be oval, round and irregular. Mean width of CG was 2.24 mm and mean length was 3.50 mm. Concerning the roots, all 3 roots were present in 29 (72.5%) cases. Absence of motor root was found in 7 (17.5%) cases. Absence of sympathetic root was found in 4 (5%) cases. The number of motor root could be 1, 2 and also 3 roots. Three motor roots were found in 1 case which originated from nerve to inferior oblique muscle. Only one sensory root was found in every specimen. One sympathetic root could be observed in most of the specimens and 6–14 short ciliary nerves were found. Mean distances from CG to posterior end of globe, optic nerve, lateral rectus muscle and its scleral insertion were 16.04 mm, 1.47 mm, 2.88 mm, and 31.53 mm, respectively.

Conclusions: This study described the characteristic of CG, number of its nerve root and some measurements relevant to intraorbital procedures in Asian population. Moreover, a new parameter was the distance between CG and scleral insertion of the lateral rectus muscle. This parameter should be considered when performing operation involved the lateral rectus muscle and BTX-A injection to lateral rectus muscle to reduce CG injury.

Abstract

Background: Ciliary ganglion (CG) can be easily injured without notice in many intraorbital procedures. Surgical procedures approaching the lateral side of the orbit are at risk of CG injury which results in transient mydriasis and tonic pupil. This study aims to focus on the morphometric study of the CG which is pertinent to intraoperative procedure.

Materials and methods: Forty embalmed cadaveric globes were dissected to observe the location, shape and size of CG, characteristics and number of roots reaching CG, number of short ciliary nerve in the orbit. Distances from CG to posterior end of globe, optic nerve, lateral rectus muscle and its scleral insertion were measured.

Results: Ciliary ganglion was located between optic nerve and lateral rectus in every case. Its shape could be oval, round and irregular. Mean width of CG was 2.24 mm and mean length was 3.50 mm. Concerning the roots, all 3 roots were present in 29 (72.5%) cases. Absence of motor root was found in 7 (17.5%) cases. Absence of sympathetic root was found in 4 (5%) cases. The number of motor root could be 1, 2 and also 3 roots. Three motor roots were found in 1 case which originated from nerve to inferior oblique muscle. Only one sensory root was found in every specimen. One sympathetic root could be observed in most of the specimens and 6–14 short ciliary nerves were found. Mean distances from CG to posterior end of globe, optic nerve, lateral rectus muscle and its scleral insertion were 16.04 mm, 1.47 mm, 2.88 mm, and 31.53 mm, respectively.

Conclusions: This study described the characteristic of CG, number of its nerve root and some measurements relevant to intraorbital procedures in Asian population. Moreover, a new parameter was the distance between CG and scleral insertion of the lateral rectus muscle. This parameter should be considered when performing operation involved the lateral rectus muscle and BTX-A injection to lateral rectus muscle to reduce CG injury.

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Keywords

ciliary ganglion; mydriasis; tonic pupil

About this article
Title

Morphometric study of the ciliary ganglion and its pertinent intraorbital procedure

Journal

Folia Morphologica

Issue

Vol 79, No 3 (2020)

Pages

438-444

Published online

2019-10-16

DOI

10.5603/FM.a2019.0112

Pubmed

31621056

Bibliographic record

Folia Morphol 2020;79(3):438-444.

Keywords

ciliary ganglion
mydriasis
tonic pupil

Authors

L. Tesapirat
S. Jariyakosol
V. Chentanez

References (29)
  1. Akkaya S, Kökcen HK, Atakan T. Unilateral transient mydriasis and ptosis after botulinum toxin injection for a cosmetic procedure. Clin Ophthalmol. 2015; 9: 313–315.
  2. American Academy of Opthalmology. Orbit, eyelids, and lacrimal system.American Academy of Opthalmology, San Francisco 2015.
  3. Arai H, Sato K, Katsuta T, et al. Lateral approach to intraorbital lesions: anatomic and surgical considerations. Neurosurgery. 1996; 39(6): 1157–62; discussion 1162.
  4. Blessing NW, Tse DT. Optic nerve sheath fenestration: a revised lateral approach for nerve access. Orbit. 2019; 38(2): 137–143.
  5. Bodker FS, Cytryn AS, Putterman AM, et al. Postoperative mydriasis after repair of orbital floor fracture. Am J Ophthalmol. 1993; 115(3): 372–375.
  6. Christiansen SP, Chandler DL, Lee KA, et al. Tonic pupil after botulinum toxin-A injection for treatment of esotropia in children. J AAPOS. 2016; 20(1): 78–81.
  7. Demer JL, Ortube MC, Engle EC, et al. High-resolution magnetic resonance imaging demonstrates abnormalities of motor nerves and extraocular muscles in patients with neuropathic strabismus. J AAPOS. 2006; 10(2): 135–142.
  8. Düz B, Secer HI, Gonul E. Endoscopic approaches to the orbit: a cadaveric study. Minim Invasive Neurosurg. 2009; 52(3): 107–113.
  9. Gilbert AL, Chwalisz B, Mallery R. Complications of optic nerve sheath fenestration as a treatment for idiopathic intracranial hypertension. Semin Ophthalmol. 2018; 33(1): 36–41.
  10. Girijavallabhan V, Bhat KMR. Positional variation of the ciliary ganglion and its clinical relevance. Neuroanatomy. 2008; 7: 38–40.
  11. Gönül E, Erdogan E, Düz B, et al. Transmaxillary approach to the orbit: an anatomic study. Neurosurgery. 2003; 53(4): 935–41; discussion 941.
  12. Gönül E, Timurkaynak E. Lateral approach to the orbit: an anatomical study. Neurosurg Rev. 1998; 21(2-3): 111–116.
  13. Hamel O, Corre P, Ploteau S, et al. Ciliary ganglion afferents and efferents variations: a possible explanation of postganglionic mydriasis. Surg Radiol Anat. 2012; 34(10): 897–902.
  14. Hemmerdinger C, Srinivasan S, Marsh IB. Reversible pupillary dilation following botulinum toxin injection to the lateral rectus. Eye (Lond). 2006; 20(12): 1478–1479.
  15. Hornblass A. Pupillary dilatation in fractures of the floor of the orbit. Ophthalmic Surg. 1979; 10(11): 44–46.
  16. Izci Y, Gonul E. The microsurgical anatomy of the ciliary ganglion and its clinical importance in orbital traumas: an anatomic study. Minim Invasive Neurosurg. 2006; 49(3): 156–160.
  17. Johnston JA, Parkinson D. Intracranial sympathetic pathways associated with the sixth cranial nerve. J Neurosurg. 1974; 40(2): 236–243.
  18. Kaptanoglu E, Solaroglu I, Okutan O, et al. Lateral orbital approach to intraorbital lesions. J Ankara Med School. 2002; 24: 171–182.
  19. Ko MW. Optic disc swelling: papilledema and other cause. In: Liu GT, Volpe NJ, SL G (ed.)Neuro-opthalmology: diagnosis and management: 3 ed. Elsevier, China 2018: 197–235.
  20. Kushner B. How to perform superior surgery on the Inferior oblique and avoid inferior surgery on the Superior oblique. Strabismus. 2017: 221–239.
  21. Lee JIl, Kang SJ, Jeon SP, et al. Transient anisocoria during medial blowout fracture surgery. Arch Craniofac Surg. 2016; 17(3): 154–157.
  22. Lee KAh. Anisocoria after repair of blowout fracture. J Craniofac Surg. 2017; 28(5): 1289–1290.
  23. McGee S. The pupils. In: Mcgee S (ed). Evidence-based physical diagnosis: 4 ed. Elsveir, Philadephia 2018: 161–183.
  24. Natori Y, Rhoton AL. Microsurgical anatomy of the superior orbital fissure. Neurosurgery. 1995; 36(4): 762–775.
  25. Neuhuber W, Schrödl F. Autonomic control of the eye and the iris. Auton Neurosci. 2011; 165(1): 67–79.
  26. Sinnreich Z, Nathan H. The ciliary ganglion in man (anatomical observations). Anat Anz. 1981; 150(3): 287–297.
  27. Thompson HS, Kardon RH. The Argyll Robertson pupil. J Neuroophthalmol. 2006; 26(2): 134–138.
  28. Corbett JJ, Nerad JA, Tse DT, et al. Optic nerve sheath fenestration in pseudotumor cerebri. A lateral orbitotomy approach. Arch Ophthalmol. 1988; 106(10): 1458–1462.
  29. Yeo MS, Al-Mousa R, Sundar G, et al. Mydriasis during orbital floor fracture reconstruction: a novel diagnostic and treatment algorithm. Craniomaxillofac Trauma Reconstr. 2010; 3(4): 209–216.

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