Abnormal Head Posture in Unilateral Superior Oblique Palsy

Khorrami-Nejad, Masoud; Akbari, Mohammadreza; Kangari, Haleh; Baghban, Alireza Akbarzadeh; Masoomian, Babak; Ranjbar-Pazooki, Mahsa

doi:10.1080/2576117x.2020.1845561

Cited by 9 publications

(12 citation statements)

References 16 publications

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“…Due to head tilt, facial muscles stretch on the opposite side of the head tilt, and face compression occurs on the same side. [7,10,16] The frequency of one-sided face and nostril compression did not have any significant difference between both facial sides in pure head turn patients. However, in most patients with pure head turn, columella was deviated on the opposite side of head turn.…”

Section: Discussionmentioning

confidence: 80%

“…A congenital etiology for upshoot in adduction was confirmed based on the patient's childhood photographs, absence of diplopia, and long-term history of strabismus. [16] The exact manifestation of abnormal head posture was determined by direct observation from different axes. "Head tilt" was defined as rotating the head around the anterioposterior axis of the skull and "head turn" as the rotation of the anterioposterior axis of the skull from the normal position.…”

Section: Methodsmentioning

confidence: 99%

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Does Head Tilt Influence Facial Appearance More Than Head Turn?

Akbari,

Khorrami-Nejad,

Kangari

et al. 2023

JOVR

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Purpose: To evaluate the frequency of facial asymmetry parameters in patients with head tilt versus those with head turn. Methods: This cross-sectional comparative study was performed on 155 cases, including 58 patients with congenital pure head turn due to Duane retraction syndrome (DRS), 33 patients with congenital pure head tilt due to upshoot in adduction or DRS, and 64 orthotropic subjects as the control group. The facial appearance was evaluated by computerized analysis of digital photographs of patients’ faces. Relative facial size (the ratio of the distance between the external canthus and the corner of the lips of both face sides) and facial angle (the angular difference between a line that connects two external canthi and another line that connects the two corners of the lips) measured as quantitative facial parameters. Qualitative parameters were evaluated by the presence of one-sided face, cheek, and nostril compression; and columella deviation. Results: The facial asymmetry frequency in patients with head tilt, head turn, and orthotropic subjects was observed in 32 (97%), 50 (86.2%), and 22 (34.3%), respectively (P < 0.001). In patients with head tilt and head turn, the mean facial angle was 1.78º ± 1.01º and 1.19º ± 0.84º, respectively (P = 0.004) and the mean relative facial size was 1.027 ± 0.018 and 1.018 ± 0.014, respectively (P = 0.018). The frequencies of one-sided nostril compression, cheek compression, face compression, and columella deviation in patients with pure head tilt were found in 19 (58%), 21 (64%), 19 (58%), and 19 (58%) patients, respectively, and in patients with pure head turn the frequencies were observed in 42 (72%), 37 (63%), 27 (47%), and 43 (74%), respectively. All quantitative and qualitative facial asymmetry parameters and facial asymmetry frequencies were significantly higher in head tilt and head turn patients as compared to the control group (P < 0.001). Conclusion: All facial asymmetry parameters in patients with head tilt and head turn were significantly higher than orthotropic subjects. The quantitative parameters such as relative facial size and facial angle were significantly higher in patients with pure head tilt than pure head turn. The results revealed that pure head tilt was associated with a higher prevalence of facial asymmetry than pure head turn.

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Section: Discussionmentioning

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Does Head Tilt Influence Facial Appearance More Than Head Turn?

Akbari,

Khorrami-Nejad,

Kangari

et al. 2023

JOVR

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“…Three main manifestations of AHP could be observed: 1-pure head tilt, 2-simultaneous head tilt and face turn, and 3-pure face turn. 24 In addition, in some patients, chin-up and chin-down could be observed alone or in combination with other main mentioned manifestations. The definition of head tilt is rotating the head around the anteroposterior axis of the skull, and head turn is the rotation of the anteroposterior axis of the skull from the normal position.…”

Section: R Esultsmentioning

confidence: 99%

Ocular abnormal head posture: A literature review

et al. 2021

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Purpose: To provide a comprehensive review on different characteristics of abnormal head postures (AHPs) due to different ocular causes, its measurement, and its effect on facial appearance. Methods: In this review article, PubMed, Scopus, and Google Scholar search engines were searched for the scientific articles and books published between 1975 and September 2020 based on the keywords of this article. The selected articles were collected, summarized, classified, evaluated, and finally concluded. Results: AHP can be caused by various ocular or nonocular diseases. The prevalence of ocular causes of AHP was reported to be 18%–25%. 1.1% of patients presenting to ophthalmology clinics has AHP. The first step in evaluating a patient with AHP is a correct differential diagnosis between nonocular and ocular sources by performing comprehensive eye examinations and ruling out other causes of orthopedic and neurological AHP. Ocular AHP occurs for a variety of reasons, the most important of which include nystagmus, superior oblique palsy, and Duane's retraction syndrome. AHP may be an essential clinical sign for an underlying disease, which can only be appropriately treated by the accurate determination of the cause. Long-standing AHP may lead to facial asymmetry and secondary muscular and skeletal changes. Conclusion: In conclusion, a proper differential diagnosis between nonocular and ocular causes, knowledge of the different forms of AHP and their measurement methods, accurate diagnosis of the cause, and proper and timely treatment of ocular AHP can prevent facial asymmetry and secondary muscular and skeletal changes in the patients.

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“…This is felt to be a compensatory adaptation that minimizes ocular misalignment and allows binocular fusion. 12 In the long term, torticollis may cause changes in the patient's face, such as facial hemihypoplasia, columella, and nasal tip deviation, and unilateral cheek compression, resulting in facial asymmetry. 1,2,[7][8][9][13][14][15] To the best of our knowledge, no study has evaluated the facial asymmetry characteristics in different forms of torticollis caused by congenital superior oblique palsy.…”

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confidence: 99%

“…These patients tend to tilt and turn their heads to the contralateral side of the palsy. This is felt to be a compensatory adaptation that minimizes ocular misalignment and allows binocular fusion 12 . In the long term, torticollis may cause changes in the patient's face, such as facial hemihypoplasia, columella, and nasal tip deviation, and unilateral cheek compression, resulting in facial asymmetry 1,2,7–9,13–15 …”

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confidence: 99%

Facial Asymmetry in Unilateral Congenital Superior Oblique Muscle Palsy

et al. 2021

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This study was conducted to evaluate facial asymmetry in unilateral congenital superior oblique muscle palsy (SOP). The results showed that all facial asymmetry parameters had a higher frequency in SOP patients compared with orthotropic individuals.PURPOSE: This study aimed to evaluate the characteristics of facial asymmetry in unilateral congenital SOP and compare with orthotropic individuals.METHODS: This cross-sectional comparative case series was conducted in 58 patients with ocular torticollis caused by SOP (mean ± standard deviation age, 18 ± 12 years) and 58 orthotropic individuals (mean ± standard deviation age, 19 ± 13 years). The exact form of torticollis was determined by direct observation from yaw, roll, and pitch axes. Four photographs were taken from patients: (1) with torticollis to calculate the amount of head tilt; (2) with the head in the straight position to calculate the facial angle and relative facial size (RFS); and (3 and 4) with the head positioned downward (to compare the cheek size) and upward (to assess columella deviation and nostril asymmetry).RESULTS: Twenty-nine patients (50%) had a head tilt, 23 (39.66%) had combined head tilt and a face turn, and 6 (10.44%) had a pure face turn. The mean ± standard deviation of head tilt, facial angle, and RFS was 10.11 ± 6.31°, 1.11 ± 1.67°, and 1.003 ± 0.126 in SOP patients, respectively, and the mean RFS and facial angle were significantly higher in SOP patients compared with orthotropic individuals (both P < .001). Facial hemihypoplasia, unilateral cheek compression, nostril asymmetry, and columella deviation were observed in 43 (74.1%), 31 (53.4%), 39 (67.2%), and 38 patients (65.5%), respectively, which were all significantly more common compared orthotropic individuals ( P < .001). Facial asymmetry was seen in 52 patients (91.2%) and 17 orthotropic subjects (29.3%), respectively ( P < .001).CONCLUSIONS: All quantitative and qualitative facial asymmetry parameters had a higher frequency in SOP patients compared with orthotropic subjects.

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Abnormal Head Posture in Unilateral Superior Oblique Palsy

Cited by 9 publications

References 16 publications

Does Head Tilt Influence Facial Appearance More Than Head Turn?

Does Head Tilt Influence Facial Appearance More Than Head Turn?

Ocular abnormal head posture: A literature review

Facial Asymmetry in Unilateral Congenital Superior Oblique Muscle Palsy

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