How Successful is Combined Superior and Inferior Oblique Muscle Surgery in Young Children with Superior Oblique Underaction Presenting in Infancy with a Severe Head Tilt?
Background/Objective: To evaluate the success of combining ipsilateral inferior and superior oblique muscle surgery in young children with congenital unilateral superior oblique under action who present in infancy with a large socially noticeable head-tilt. Methods: A consecutive retrospective case...
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| Format: | Article |
| Language: | English |
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White Rose University Press
2021-02-01
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| Series: | British and Irish Orthoptic Journal |
| Subjects: | |
| Online Access: | https://www.bioj-online.com/articles/171 |
| _version_ | 1818429654455812096 |
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| author | Revelle A. Littlewood John P. Burke |
| author_facet | Revelle A. Littlewood John P. Burke |
| author_sort | Revelle A. Littlewood |
| collection | DOAJ |
| description | Background/Objective: To evaluate the success of combining ipsilateral inferior and superior oblique muscle surgery in young children with congenital unilateral superior oblique under action who present in infancy with a large socially noticeable head-tilt. Methods: A consecutive retrospective case series of young children was analysed. The success of surgery in eliminating the head-tilt was evaluated by pre- and postoperative ocular motility assessment focusing on the vertical misalignment in primary position and downgaze, the magnitude of the head-tilt in degrees and the status of the superior oblique tendon. Results: Five children had a mean age at first surgery of 41 (range 25–63) months, a mean primary position vertical deviation of 26 (25–30) prism dioptres, a head-tilt of 30 (20–35) degrees and a mean post-operative follow up of 24 (8–43) months. While there was a uniform surgical plan, nonetheless each operation required individualisation based on a spectrum of per-operative superior oblique tendon findings. The head tilt was eliminated in 40% and reduced in the remainder, to a mean of 7 (0–18) degrees and with a mean post-operative primary position vertical misalignment of 3 (range 0–10) and of 10 (range 0–40) prism dioptres in downgaze. Conclusion: Combined, ipsilateral oblique muscle surgery reduced the severe head tilt and primary position alignment to a psychosocially and functionally acceptable level. For the majority, the outcome was stable or associated with further decremental improvement. A persistent downgaze vertical tropia occurred in children with macroscopically abnormal superior oblique tendons but these cases were not identifiable clinically pre-operatively. |
| first_indexed | 2024-12-14T15:20:57Z |
| format | Article |
| id | doaj.art-a7666967a775418cbff99634c33874e6 |
| institution | Directory Open Access Journal |
| issn | 2516-3590 |
| language | English |
| last_indexed | 2024-12-14T15:20:57Z |
| publishDate | 2021-02-01 |
| publisher | White Rose University Press |
| record_format | Article |
| series | British and Irish Orthoptic Journal |
| spelling | doaj.art-a7666967a775418cbff99634c33874e62022-12-21T22:56:10ZengWhite Rose University PressBritish and Irish Orthoptic Journal2516-35902021-02-0117110.22599/bioj.171150How Successful is Combined Superior and Inferior Oblique Muscle Surgery in Young Children with Superior Oblique Underaction Presenting in Infancy with a Severe Head Tilt?Revelle A. Littlewood0John P. Burke1Sheffield Teaching Hospitals NHSFTSheffield Teaching Hospitals NHSFTBackground/Objective: To evaluate the success of combining ipsilateral inferior and superior oblique muscle surgery in young children with congenital unilateral superior oblique under action who present in infancy with a large socially noticeable head-tilt. Methods: A consecutive retrospective case series of young children was analysed. The success of surgery in eliminating the head-tilt was evaluated by pre- and postoperative ocular motility assessment focusing on the vertical misalignment in primary position and downgaze, the magnitude of the head-tilt in degrees and the status of the superior oblique tendon. Results: Five children had a mean age at first surgery of 41 (range 25–63) months, a mean primary position vertical deviation of 26 (25–30) prism dioptres, a head-tilt of 30 (20–35) degrees and a mean post-operative follow up of 24 (8–43) months. While there was a uniform surgical plan, nonetheless each operation required individualisation based on a spectrum of per-operative superior oblique tendon findings. The head tilt was eliminated in 40% and reduced in the remainder, to a mean of 7 (0–18) degrees and with a mean post-operative primary position vertical misalignment of 3 (range 0–10) and of 10 (range 0–40) prism dioptres in downgaze. Conclusion: Combined, ipsilateral oblique muscle surgery reduced the severe head tilt and primary position alignment to a psychosocially and functionally acceptable level. For the majority, the outcome was stable or associated with further decremental improvement. A persistent downgaze vertical tropia occurred in children with macroscopically abnormal superior oblique tendons but these cases were not identifiable clinically pre-operatively.https://www.bioj-online.com/articles/171congenital superior oblique palsytorticollisvertical diplopia |
| spellingShingle | Revelle A. Littlewood John P. Burke How Successful is Combined Superior and Inferior Oblique Muscle Surgery in Young Children with Superior Oblique Underaction Presenting in Infancy with a Severe Head Tilt? British and Irish Orthoptic Journal congenital superior oblique palsy torticollis vertical diplopia |
| title | How Successful is Combined Superior and Inferior Oblique Muscle Surgery in Young Children with Superior Oblique Underaction Presenting in Infancy with a Severe Head Tilt? |
| title_full | How Successful is Combined Superior and Inferior Oblique Muscle Surgery in Young Children with Superior Oblique Underaction Presenting in Infancy with a Severe Head Tilt? |
| title_fullStr | How Successful is Combined Superior and Inferior Oblique Muscle Surgery in Young Children with Superior Oblique Underaction Presenting in Infancy with a Severe Head Tilt? |
| title_full_unstemmed | How Successful is Combined Superior and Inferior Oblique Muscle Surgery in Young Children with Superior Oblique Underaction Presenting in Infancy with a Severe Head Tilt? |
| title_short | How Successful is Combined Superior and Inferior Oblique Muscle Surgery in Young Children with Superior Oblique Underaction Presenting in Infancy with a Severe Head Tilt? |
| title_sort | how successful is combined superior and inferior oblique muscle surgery in young children with superior oblique underaction presenting in infancy with a severe head tilt |
| topic | congenital superior oblique palsy torticollis vertical diplopia |
| url | https://www.bioj-online.com/articles/171 |
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