A Prospective Study of the Relationship Between Strabismus and Head Posture in Patients with Frontal Plagiocephaly

Abstract

A prospective study was performed on 16 unoperated patients with frontal plagiocephaly to characterize the relationship between strabismus and abnormal head posture. Serial eye examinations were performed preoperatively and for 24 to 46 months following fronto-orbital advancement. In 14 patients (88 percent), preoperative clinical examination and CT scan indicated coronal plagiocephaly (synostotic); unicoronal synostosis was documented during fronto-orbital advancement in all these patients. Ten patients had abnormal head posture on preoperative examination, 9 of whom had strabismus at some time during the study. These 9 patients all had unicoronal synostosis with ipsilateral strabismus and a contralateral head tilt. All had eye muscle findings consistent with superior oblique paresis, although in 2 patients these signs first developed following fronto-orbital advancement. Strabismus resolved spontaneously in 2 patients between 2 and 8 months following fronto-orbital advancement; the remaining 7 patients underwent extraocular muscle surgery following fronto-orbital advancement, with early resolution of strabismus in all cases. The head tilt resolved or improved significantly in all 9 patients following resolution of the strabismus. Two patients had recurrent superior oblique paresis following surgical correction, necessitating secondary strabismus surgery. The present study indicates that extraocular muscle dysfunction is the major cause of abnormal head posture in patients with coronal plagiocephaly and emphasizes the need for long-term ophthalmologic surveillance in these patients.

Early treatment of coronal synostosis with endoscopy-assisted craniectomy and postoperative cranial orthosis therapy: 16-year experience

“…Included among these are V-pattern strabismus, excyclotorsion, aniso-astigmatism, and amblyopia. The estimated incidence of V-pattern strabismus has been reported as 81%, 28 50%, 7 and 57.6% 21 in different studies. In a recent study comparing the ophthalmological findings of endoscopic strip craniectomy versus frontoorbital advancement, MacKinnon et al 22 found that the endoscopic craniectomy patients developed less severe V-pattern strabismus, excyclotorsion of the fundus, and range of aniso-astigmatisms.…”

Treatment of unilateral coronal synostosis by endoscopic strip craniectomy or fronto-orbital advancement: Ophthalmologic findings

“…The associated strabismus and ocular torticollis have been attributed to these orbital changes. [1][2][3][4][5][6][7][8] The majority of patients also develop aniso-astigmatism and, accordingly, may have an increased risk of amblyopia. 4,9 Although correction of unilateral coronal synostosis by fronto-orbital advancement (FOA) improves the orbital symmetry anterior to the axis of the globe, some posterior asymmetry may persist.…”

Amblyogenic anisometropia in the contralateral eye in unicoronal craniosynostosis

“…Strabismus in this condition is common, frequently associated with apparent oblique muscle dysfunction ipsilateral to the side of the synostosis. 4,5,8,[11][12][13] Asymmetry of refractive error in unicoronal craniosynostosis is less well described in the literature. The authors of one study 5 reported an anisoastigmatism of 1.5 D or greater absolute cylindrical refractive error in 9 of 39 children with unicoronal craniosynostosis, involving the ipsilateral or the contralateral eye with almost equal frequency.…”