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Effect of strabismus surgery on torticollis caused by congenital superior oblique palsy in young children.

Kekunnaya R, Isenberg SJ - Indian J Ophthalmol (2014)

Bottom Line: The head tilt reduced from mean of 17 ± 9 to 2 ± 2 degrees ( P < 0.0001).The success rate for achieving both criteria was 61.5% (C.I. 35-88%).About one-third required an additional procedure, which led to total normalization of the head position.

View Article: PubMed Central - PubMed

Affiliation: Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, India; Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, USA, .

ABSTRACT

Purpose: To evaluate the outcome of strabismus surgery for congenital superior oblique palsy (SOP) in relation to correction of head tilt and hypertropia. The cohort of patients mainly involved very young children. This is the first study to use a standardized instrument to objectively measure torticollis before and after surgery.

Materials and methods: A non-comparative interventional case series of 13 cases of congenital superior oblique palsy with head tilt, who underwent simultaneous superior oblique tuck and inferior oblique recession between Jan 2000 and Dec 2008, were studied.

Results: The mean duration of SOP until surgery was 36.8 months. Of the 12 unilateral cases, 8 were right-sided. Mean follow-up period was 17 months (range 7-36). The outcome was determined at the last follow-up. Mean pre-and post-operative hypertropia (p.d.) in forced primary position was 19 ± 7 and 2 ± 6, respectively ( P < 0.0001). The head tilt reduced from mean of 17 ± 9 to 2 ± 2 degrees ( P < 0.0001). Success, defined as hypertropia <5 PD and head tilt less than 5 degrees, was achieved in 69% (9/13. C.I. 42-88%) and 85% (11/13. C.I. 56-96%), respectively. The success rate for achieving both criteria was 61.5% (C.I. 35-88%). Five patients required additional surgery; usually a contralateral inferior rectus muscle recession, which was successful in all cases. One case developed asymptomatic Brown syndrome (7.69% - C.I. 6.7-22.2).

Conclusions: Simultaneous superior oblique tuck and inferior oblique muscle recession can successfully treat selected cases of congenital superior oblique palsy. About one-third required an additional procedure, which led to total normalization of the head position.

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Related in: MedlinePlus

Measurement of head tilt using a goniometer: One arm is lined up with the vertical edge of the door while the other is aligned across the medial and lateral canthus of each eye
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Figure 1: Measurement of head tilt using a goniometer: One arm is lined up with the vertical edge of the door while the other is aligned across the medial and lateral canthus of each eye

Mentions: A goniometer (By Baseline products, White plains, NEW YORK) is an instrument with graded markings, commonly used to measure the range of joint movement and deformity. During measurement, the patient is fixated on a distant target at eye level. One arm of the goniometer was placed parallel to the axis of the face, and the second arm perpendicular to the floor [Fig. 1]. It is helpful to align the second arm with a vertical object, such as a door post.


Effect of strabismus surgery on torticollis caused by congenital superior oblique palsy in young children.

Kekunnaya R, Isenberg SJ - Indian J Ophthalmol (2014)

Measurement of head tilt using a goniometer: One arm is lined up with the vertical edge of the door while the other is aligned across the medial and lateral canthus of each eye
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061671&req=5

Figure 1: Measurement of head tilt using a goniometer: One arm is lined up with the vertical edge of the door while the other is aligned across the medial and lateral canthus of each eye
Mentions: A goniometer (By Baseline products, White plains, NEW YORK) is an instrument with graded markings, commonly used to measure the range of joint movement and deformity. During measurement, the patient is fixated on a distant target at eye level. One arm of the goniometer was placed parallel to the axis of the face, and the second arm perpendicular to the floor [Fig. 1]. It is helpful to align the second arm with a vertical object, such as a door post.

Bottom Line: The head tilt reduced from mean of 17 ± 9 to 2 ± 2 degrees ( P < 0.0001).The success rate for achieving both criteria was 61.5% (C.I. 35-88%).About one-third required an additional procedure, which led to total normalization of the head position.

View Article: PubMed Central - PubMed

Affiliation: Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, India; Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, USA, .

ABSTRACT

Purpose: To evaluate the outcome of strabismus surgery for congenital superior oblique palsy (SOP) in relation to correction of head tilt and hypertropia. The cohort of patients mainly involved very young children. This is the first study to use a standardized instrument to objectively measure torticollis before and after surgery.

Materials and methods: A non-comparative interventional case series of 13 cases of congenital superior oblique palsy with head tilt, who underwent simultaneous superior oblique tuck and inferior oblique recession between Jan 2000 and Dec 2008, were studied.

Results: The mean duration of SOP until surgery was 36.8 months. Of the 12 unilateral cases, 8 were right-sided. Mean follow-up period was 17 months (range 7-36). The outcome was determined at the last follow-up. Mean pre-and post-operative hypertropia (p.d.) in forced primary position was 19 ± 7 and 2 ± 6, respectively ( P < 0.0001). The head tilt reduced from mean of 17 ± 9 to 2 ± 2 degrees ( P < 0.0001). Success, defined as hypertropia <5 PD and head tilt less than 5 degrees, was achieved in 69% (9/13. C.I. 42-88%) and 85% (11/13. C.I. 56-96%), respectively. The success rate for achieving both criteria was 61.5% (C.I. 35-88%). Five patients required additional surgery; usually a contralateral inferior rectus muscle recession, which was successful in all cases. One case developed asymptomatic Brown syndrome (7.69% - C.I. 6.7-22.2).

Conclusions: Simultaneous superior oblique tuck and inferior oblique muscle recession can successfully treat selected cases of congenital superior oblique palsy. About one-third required an additional procedure, which led to total normalization of the head position.

Show MeSH
Related in: MedlinePlus