Odehnal M, Malec J
Dĕtská ocní klinika 2. LF UK, Praha Motol.
Cesk Slov Oftalmol. 2002 Sep;58(5):307-14.
Aberrant innervations of oculomotor muscles are a special group of clinical entities, the common sign of which is an abnormal innervation of the oculomotor muscles with nerve fibres which originally were not meant for this purpose. The majority of these anomalies develops during the embryonic period of lesions at the level of nuclei of cranial nerves or peripheral fibres. Congenital aberrations affect most frequently n. VI, less frequently n. III and rarely n. IV. Acquired affections are most frequent in n. III. Abnormal innervation connections concern not only oculomotor muscles but also muscles engaged in mastication and those of the upper eyelid. Clinically they are manifested as eyelid and facial synkinesias. Among aberrant innervations which lack an uniform terminology belong according to the more recent classification the following clinical units: Duan's syndrome, synergic divergence, double-elevator palsy, misdirection syndrome, Marcus Gunn phenomenon, some forms of congenital fibrous syndrome, trigemino-abducens synkinesia, pseudohyperfunction of the lower oblique muscle, crocodile tears syndrome, and aberrant affection of n. III. The authors describe the course, possible etiology of these anomalies and demonstrate, based on their own observations, clinical cases which can be explained by these mechanisms.
动眼肌的异常神经支配是一组特殊的临床病症，其共同特征是动眼肌由原本并非用于此目的的神经纤维进行异常神经支配。这些异常大多在胚胎期因颅神经核或周围纤维层面的病变而发生。先天性异常最常累及第六神经，较少累及第三神经，极少累及第四神经。后天性病变最常见于第三神经。异常的神经支配连接不仅涉及动眼肌，还涉及咀嚼肌和上睑肌。临床上表现为眼睑和面部联带运动。在缺乏统一术语的异常神经支配中，根据最新分类包括以下临床类型：段氏综合征、协同性散开、双上直肌麻痹、错向综合征、Marcus Gunn现象、某些形式的先天性纤维综合征、三叉神经 - 外展神经联带运动、下斜肌假性亢进、鳄鱼泪综合征以及第三神经的异常病变。作者描述了这些异常的病程、可能的病因，并基于自身观察展示了可用这些机制解释的临床病例。
