PURPOSE: To describe our experience with myectomy of the superior oblique muscle combined with resection of the trochlea for recurrent or primary superior oblique myokymia (SOM). DESIGN: Retrospective, interventional case series. METHODS: We performed superior oblique myectomy combined with resection of the trochlea in 3 patients with SOM in whom medical management had failed. In 2 patients, the symptoms of myokymia were recurrent after previous superior oblique tenectomy, and in 1 patient, our procedure was the first surgery. RESULTS: All 3 patients have experienced complete symptomatic relief from SOM with follow-up ranging from 1 to 22 years. Iatrogenic superior oblique palsy has been managed in each patient. Dysesthesia in the infratrochlear and supratrochlear regions was judged by each patient to be much less bothersome than the symptoms of SOM. CONCLUSIONS: We recommend myectomy of the superior oblique muscle combined with resection of the trochlea if symptoms of SOM recur after a prior superior oblique tenectomy. Based on this small series with long follow-up, the procedure also may be considered as the primary operation for SOM that fails medical management.
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