J AAPOS. 2025 Apr;29(2):104155. doi: 10.1016/j.jaapos.2025.104155. Epub 2025 Feb 27.

ABSTRACT

PURPOSE: To present a novel surgical technique of superior oblique tendon elongation for Brown syndrome using bovine pericardium (Tutopatch).

METHODS: Ten children (2-7 years old) with unilateral Brown syndrome were included. All patients had significant to severe underelevation in adduction, with hypotropia in primary gaze and anomalous head posture. The superior oblique was tenotomized and a Tutopatch implant, length 8-10 mm, was inserted to elongate the muscle tendon. The children were examined 1 day and 6 months postoperatively.

RESULTS: Of the 10 patients, 8 demonstrated significant improvement in duction and anomalous head posture. Two patients required an additional procedure, in one case due to secondary overelevation in adduction, and in the other because of undercorrection.

CONCLUSIONS: In our small patient cohort, superior oblique tendon elongation using Tutopatch implant improved ductions and anomalous head posture due to Brown syndrome. This technique offers a controlled weakening of the superior oblique muscle similar in effect to an implanted silicon expander but without involving artificial materials.

PMID:40020771 | DOI:10.1016/j.jaapos.2025.104155