Facial Asymmetry in Unilateral Congenital Superior Oblique Muscle Palsy

Abstract

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.

Does Head Tilt Influence Facial Appearance More Than Head Turn?

“…However, it is important to consider that ectopia may happen in patients with nonsyndromic craniosynostosis (e.g., plagiocephaly), non-paretic motility disorders because of an extorted position of the orbit and pulley. [20,21] In some abnormal head posture causes such as superior oblique palsy, the abnormal head posture would manifest as head tilt or head turn or a combination of them. In a study by Turan et al, four different types of abnormal head posture in patients with superior oblique palsy was reported.…”

“…However, it is important to consider that ectopia may happen in patients with nonsyndromic craniosynostosis (e.g., plagiocephaly), non-paretic motility disorders because of an extorted position of the orbit and pulley. [ 20 , 21 ]…”

Clinical characteristics and surgical outcomes in patients with superior oblique muscle palsy: a retrospective study on 1057 patients

“…Abnormal head postures (head tilt and face turn) can help patients to get rid of diplopia [ 4 ]. Facial asymmetry and large vertical fusional amplitudes indicate chronicity [ 7 ]. A review of old photography to verify chronicity can avoid unnecessary neurologic evaluation [ 8 , 9 ].…”