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Strabismus in craniofacial dysostosis
1Department of Ophthalmology, University of British Columbia, Canada.
Insights
Craniofacial dysostosis surgery in children, including Apert
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Ophthalmology
Background:
- Craniofacial dysostosis syndromes like Apert and Crouzon require complex surgical interventions.
- Orbital retrusion is a common feature necessitating craniectomies.
- Ocular motility issues can coexist with these conditions.
Observation:
- Ten pediatric patients with craniofacial dysostosis underwent craniectomies for orbital retrusion.
- Follow-up ranged from 3 months to 7 years.
- Pre-existing ocular alignment issues were noted in several patients.
Findings:
- Infantile craniectomy did not alter ocular alignment in any patient.
- Ophthalmologic anomalies included sixth nerve paresis, superior rectus weakness, ptosis, and exorbitism.
- Some patients required multiple procedures due to failed bony orbital growth.
Implications:
- Cranial vault surgery for craniofacial dysostosis does not impact pre-existing ocular alignment.
- Management of associated ophthalmologic conditions requires careful consideration.
- Long-term follow-up is crucial for patients with severe bony orbital growth failure.
Abstract:
Ten infants and children who presented with craniofacial dysostosis are discussed; four had Apert's syndrome, four had Crouzon's syndrome, one had Pfeiffer's syndrome, and one had hypertelorism. The follow-up of the patients ranged from 3 months to 7 years, with an average of 19 months. Patients had bifrontal and biparietal craniectomies to correct frontal and temporal orbital retrusion, while two had left unilateral procedures only. One patient (T.S.) had had three similar procedures before he was 3 years old and patient B.B. had two before he was 11 months old due to the complete failure of bony orbital growth. Before the cranial surgery, one patient had a preexisting esotropia with bilateral congenital sixth nerve paresis, one had a V-pattern exotropia, and one had a right intermittent hypotropia due to right superior rectus weakness. In no case was there a change in the ocular alignment after infantile craniectomy. There were assorted ophthalmologic anomalies, such as congenital bilateral sixth nerve paresis, absent superior rectus function, bilateral ptosis in addition to absent superior rectus function, and two patients presented with frank and repeated exorbitism.