An uncommon midfoot injury, naviculocuneiform and calcaneocuboid fracture dislocation: a case report.

A 57-year-old man fell from a height of 6 m and injured his right foot. Imaging studies showed an uncommon injury; naviculocuneiform and calcaneocuboid joint fracture dislocations. He underwent a temporary fixation with Kirschner wires (K-wires), and the injured foot was immobilized with a below-knee splint.

Pathogenesis and surgical correction of dynamic lower scleral show as a sign of disinsertion of the levator aponeurosis from the tarsus.

The purpose of this study was to confirm whether lower scleral show is caused by the disinsertion of the levator aponeurosis from the tarsus. Aponeurotic advancement by vascular clips or by surgery involving the orbital septum significantly lowered the global position in the orbit and significantly diminished the degree of retraction of the lower eyelid, resulting in satisfactory improvement of lower scleral show in 100 patients with various aponeurotic blepharoptosis. Therefore, we propose the pathogenesis of lower scleral show as follows: additional contraction of the levator muscle to compensate for the disinsertion of the levator aponeurosis from the tarsus for maintenance of an adequate visual field is accompanied by additional contraction of the superior rectus muscle through the strong intermuscular fascia, resulting in upward rotation of the globe.

Efferent and afferent innervations of Mueller's muscle related to involuntary contraction of the levator muscle: important for avoiding injury during eyelid surgery.

Because stretching of Mueller's muscle induces involuntary contraction of the levator muscle, we hypothesised that Mueller's muscle functions as a serial kind of muscle spindle of the levator muscle. To confirm the presence and location of efferent and afferent innervations of Mueller's muscle, cadavers' eyelids were microscopically and macroscopically examined, and the resultant findings were physiologically confirmed in patients' eyelids during surgery. Fine neural myelinated structures acting as a mechanoreceptor were found in the proximal Mueller's muscle.