Aim: To review traumatic oculomotor nerve (IIIN) palsy, looking at the prognosis, site of lesion and mechanism of recovery.
Methods: A literature review was undertaken in order to research opinions on the prognosis following a traumatic UIN palsy. The nuclear, fascicular midbrain, subarachnoid, cavernous sinus and orbital portions were investigated and the prognosis discussed.
Results: Trauma affecting the nuclear region alone is rare, but IIIN palsy can occur indirectly as a result of haemorrhage, and spontaneous recovery may be expected. Direct nuclear palsy following trauma is not prone to recovery. The midbrain is highly vulnerable to damage caused by rootlet avulsion and recovery may be further limited by post-traumatic fusion deficiency. The cavernous sinus is particularly prone to damage hut the prognosis is generally good, as is that for trauma affecting the region of the superior orbital fissure.
Conclusion: IIIN palsy as a result of trauma is not a common finding, and the extent of the trauma and the site of the lesion will, in part, determine the prognosis for recovery. The mechanism of recovery is by axonal regeneration, by a process of Wallerian degeneration and new cellular cord formation. Prognosis is unaffected by age. Consideration should be given to aetiology and the site of the traumatic lesion in the management of traumatic IIIN palsy.