Core Messages
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The superior oblique (SO) tendon is attached to the undersurface of the superior rectus muscle by an areolar frenulum.
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The frenulum, if left intact, causes the SO tendon to move posteriorly with the superior rectus muscle when it is recessed. This can prevent the SO from becoming scarred into the superior rectus insertion when the latter is recessed. It can, however, prevent the superior rectus muscle from taking up slack when recessed with a suspension technique.
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An intact frenulum can result in the SO tendon scarring into the superior rectus insertion when the latter is resected.
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The posterior SO tenectomy procedure is effective in collapsing small A patterns but often does not eliminate overdepression in adduction. This apparent contradiction can be explained by the change in SO vector force that results from cutting the frenulum, which is unavoidable with this surgical procedure.
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Kushner, B.J., Iizuka, M. (2010). Surgical Implications of the Superior Oblique Frenulum. In: Lorenz, B., Brodsky, M.C. (eds) Pediatric Ophthalmology, Neuro-Ophthalmology, Genetics. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85851-5_14
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