Aberrant regeneration of third nerve combined with sixth nerve palsy in the setting of trauma: surgical results

Introduction: Aberrant regeneration of the third nerve is a known entity after trauma. It is important to recognize signs of aberrant regeneration and keep lid aperture disparity in mind before choosing the surgical procedure in such cases. Surgical procedure in these cases is often customized on case-to-case basis. Methods: Two cases with combined third and sixth nerve palsy are described. Both the patients had synergistic adduction on elevation and were treated by a single muscle transposition. Results: Both patients were orthotropic in the primary position with no diplopia and a reduction in synergistic adduction. Conclusion: Muscle transfer in the direction of aberrant movement works reasonably well in cases of partially recovered combined palsies. We present two cases detailing the usefulness of single muscle transposition, confirming the utility of this surgical technique in cases of aberrant regeneration.