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Ocular motility in craniofacial reconstruction
Insights
Craniofacial surgery rarely causes new strabismus in children. When it occurs, it
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Craniofacial reconstruction in children can impact ocular alignment.
- Understanding the incidence and nature of strabismus post-surgery is crucial for pediatric ophthalmology.
Observation:
- 140 children undergoing major craniofacial reconstruction were evaluated.
- Only 10% experienced surgically induced horizontal alignment changes.
- Two new cases of strabismus were directly linked to cranial nerve palsies post-surgery.
Findings:
- The majority of children (130/140) did not develop new strabismus.
- Significant horizontal alignment changes (>10 prism diopters) were infrequent (4/140).
- Patients with craniofacial dysostosis (Crouzon syndrome) showed higher rates of preoperative strabismus (20/44) and required extraocular muscle surgery (12/44).
Implications:
- Early intervention for strabismus in craniofacial surgery patients may improve binocularity.
- Anomalies in extraocular muscle number/structure are associated with craniofacial dysostosis.
- Ophthalmologic assessment is vital for children undergoing craniofacial reconstruction.
Abstract:
Of 140 children undergoing major craniofacial reconstruction at The Children's Hospital of Philadelphia and examined preoperatively and postoperatively by the Ophthalmology Division, only 10 had surgically induced alteration in primary position horizontal alignment, 4 greater than 10 prism diopters. Only 2 patients had a new strabismus in primary position created by craniofacial surgery, both cranial nerve palsies. We believe early strabismus surgery is advantageous for attainment of binocularity and ease of tissue manipulation. Of 44 patients with craniofacial dysostosis (Crouzon), 20 had preoperative strabismus, and 12 required extraocular muscle surgery. Five of 12 had anomalies of extraocular muscle number and structure, usually involving the superior rectus muscle.