Facial Asymmetry in Unilateral Duane Retraction Syndrome

Abstract

SIGNIFICANCE The overall objective of this study was to evaluate facial asymmetry in patients with unilateral Duane retraction syndrome (DRS). The results showed a high frequency of facial asymmetry parameters of the opposite side of head turn in unilateral DRS patients. PURPOSE The purposes of this study were to evaluate the characteristics of facial asymmetry in unilateral exotropic and esotropic DRS and to compare the findings with orthotropic subjects. METHODS This cross-sectional comparative case series study was performed in 44 consecutive patients with head turn caused by DRS and 44 orthotropic subjects from 2016 to 2019. Four pictures were taken from the patients' faces. The first and second pictures were taken when patients had head turn and when the head was completely straight for calculating the facial angle and relative facial size, respectively. The third and fourth pictures were taken when the head was positioned downward (to compare the size of the cheek) and upward (to evaluate nose asymmetry). RESULTS The mean ± SD age of DRS patients and orthotropic subjects was 16.23 ± 9.92 and 20.68 ± 11.82 years, respectively. The frequency of facial asymmetry and all facial parameters (cheek compression, nasal tip and columella deviation, and compression of one of the nostrils) was significantly higher in DRS patients compared with orthotropic subjects (P < .001). In DRS patients with facial asymmetry, columella and nasal tip deviation (P = .006) and cheek and face compression (P = .03) were significantly more prevalent in the opposite direction of head turn. In the DRS group, the mean ± SD age of the patients with and without facial asymmetry was 17.37 ± 9.76 and 7.40 ± 6.54 years, respectively (P = .02). CONCLUSIONS The frequency of facial asymmetry and all facial parameters was significantly higher in DRS patients compared with orthotropic subjects. In unilateral DRS patients, the face was more commonly affected on the opposite side of head turn.

Ocular abnormal head posture: A literature review

“… 18 Most of the patients who have one of the above-mentioned etiologies of AHP habitually position their heads to avoid the field of action of the defective muscle, eliminate diplopia, and achieve a binocular single vision. 29 30 Although the head position does not precisely match what is expected in all cases, 23 the manifestations and the position of the head in these ocular causes are shown in Table 2 . 29 68 69 70 71 Chin-up position is a common posture in patients with bilateral ptosis including blepharophimosis syndrome.…”

“…Previous studies used a goniometer 23 27 28 (an instrument specifically designed for measuring angular differences) or computer analysis methods 29 30 to measure different manifestations of AHP. For measuring any manifestation of AHP, it is necessary that the patients fixate on a target with fine detail, or it should be measured while recording best corrected visual acuity.…”

“…For measuring any manifestation of AHP, it is necessary that the patients fixate on a target with fine detail, or it should be measured while recording best corrected visual acuity. 25 29 AHP measurement methods in different manifestations are described below.…”

“…The angle between the vertical line and the line that connects the center of the eyebrows to the center of the lip is calculated as the head tilt [ Figure 1 ]. 29 30 …”

The correlation between hypertropia and head tilt in congenital unilateral superior oblique muscle palsy

“…For evaluation of the severity of abnormal head posture and measurement of head tilt, these pictures were analyzed by the Corel Draw X7 software (version 17.0.0.491 for Windows, USA). 26 As shown in Figure 1 , the angle between the line that connects the center of the eyebrows to the center of the lip and the vertical line is measured as the angle of the head tilt.…”