Does Head Tilt Influence Facial Appearance More Than Head Turn?

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Craniofacial Surgery

Background:

• Congenital head tilt and head turn are common conditions in pediatric patients.
• Facial asymmetry can result from prolonged abnormal head posture.
• Understanding the prevalence and characteristics of facial asymmetry in these conditions is crucial for diagnosis and management.

Purpose of the Study:

• To compare the frequency and types of facial asymmetry parameters in patients with congenital head tilt versus those with congenital head turn.
• To identify specific quantitative and qualitative facial asymmetry features associated with each condition.

Main Methods:

• A cross-sectional comparative study involving 155 subjects: 58 with congenital pure head turn (Duane retraction syndrome), 33 with congenital pure head tilt (upshoot in adduction or Duane retraction syndrome), and 64 orthotropic controls.
• Computerized analysis of digital photographs to evaluate relative facial size and facial angle.
• Qualitative assessment for one-sided face, cheek, and nostril compression, and columella deviation.

Main Results:

• Facial asymmetry was significantly more frequent in head tilt (97%) and head turn (86.2%) groups compared to controls (34.3%).
• Patients with head tilt showed significantly higher mean facial angles (1.78º) and relative facial sizes (1.027) than those with head turn (1.19º and 1.018, respectively).
• Specific qualitative asymmetries like nostril compression and columella deviation were more prevalent in the head tilt group.

Conclusions:

• Both congenital head tilt and head turn are associated with significantly higher frequencies of facial asymmetry compared to orthotropic subjects.
• Congenital head tilt demonstrates a higher prevalence and severity of facial asymmetry, including quantitative and qualitative parameters, than congenital head turn.