Facial asymmetry in ocular torticollis

Abstract

Torticollis can arise from nonocular (usually musculoskeletal) and ocular conditions. Some facial asymmetries are correlated with a history of early onset ocular torticollis supported by the presence of torticollis on reviewing childhood photographs. When present in an adult, this type of facial asymmetry with an origin of ocular torticollis should help to confirm the chronicity of the defect and prevent unnecessary neurologic evaluation in patients with an uncertain history. Assessment of facial asymmetry consists of a patient history, physical examination, and medical imaging. Medical imaging and facial morphometry are helpful for objective diagnosis and measurement of the facial asymmetry, as well as for treatment planning. The facial asymmetry in congenital superior oblique palsy is typically manifested by midfacial hemihypoplasia on the side opposite the palsied muscle, with deviation of the nose and mouth toward the hypoplastic side. Correcting torticollis through strabismus surgery before a critical developmental age may prevent the development of irreversible facial asymmetry. Mild facial asymmetry associated with congenital torticollis has been reported to resolve with continued growth after early surgery, but if asymmetry is severe or is not treated in the appropriate time, it might remain even with continued growth after surgery.

Surgical treatment of Duane retraction syndrome

“…13 Evidence exists that facial musculoskeletal asymmetry may develop in the context of abnormal face turns. 14 , 15 Thus, surgery in younger age, as soon as one year old, could prevent the complications resulting from prolonged abnormal head posture.…”

“…Bilateral medial rectus recession has been recommended in unilateral DRS with more than 20 PD esotropia. 11 , 12 , 13 , 14 , 15 , 16 , 17 In some patients with severe globe retraction in which surgical plan is ipsilateral medial and lateral rectus recessions, medial rectus of unaffected eye can be recessed for correction of residual deviation. Also, in patients who have limited adduction and very slow adduction velocities in the affected eye, recession of medial rectus of contralateral eye can be done for decreasing the amount of ipsilateral medial rectus recession.…”

“…The classical treatment is an ipsilateral lateral rectus recession for deviations less than 20 diopters and bilateral lateral rectus recession for deviations more than 20 diopters with the surgical dosages more than standard surgical tables. 11 , 12 , 13 , 14 , 15 , 16 , 17 Recession of tight and shortened lateral rectus can correct the deviation and head turn and simultaneously diminishes globe retraction and overshoots in the cost of increased abduction limitation. 17 Profound weakening technique such as periosteal fixation of the lateral rectus muscle may be needed if the globe retraction is severe.…”

Characteristics of Facial Asymmetry in Congenital Superior Oblique Palsy according to Trochlear Nerve Absence

“…Congenital superior oblique palsy (SOP) is one of the most common causes of ocular torticollis in children, of which the patient tilts his or her head to use both eyes together [ 1 – 3 ]. In children with torticollis, asymmetric development of the face is an irreversible but under-recognized complication of long-standing head tilt, especially if the head tilt is intermittent or mild [ 3 – 6 ]. Facial asymmetry is progressive if the head tilt persists in young children, and early strabismus surgery to correct the head tilt may help prevent facial asymmetry in congenital SOP [ 7 ].…”

Paradoxical head tilt in unilateral traumatic superior oblique palsy

“…Patients suffering SO palsy usually adopt an abnormal head posture of contralateral head tilt as a compensating effort to reduce the hypertropia. 5 , 6 , 7 However, paradoxical ipsilateral head tilt has also been reported in minority cases of SO palsy; this phenomenon is mainly attributed to increasing the hyperdeviation in order to separate each eye's produced image widely. Further disruption of fusion is more suitable for such patients than effort needed for vertical fusional vergence.…”