The Frequency and Causes of Abnormal Head Position Based on an Ophthalmology Clinic's Findings: Is it Overlooked?

Purpose To determine the frequency of abnormal head position (AHP) and identify the underlying causes in patients who presented to an ophthalmology clinic due to any ophthalmologic complaint. Methods The medical records of patients who presented with any ophthalmologic symptoms during a 6-month period were prospectively evaluated. In all, 2,710 patients (1,492 female and 1,218 male) aged 6 months-91 years were included in the study. Each patient underwent complete ophthalmologic evaluation. Results Among the 2,710 patients, 30 (1.1%) (7 female and 23 male) with a mean age of 14.62 ± 17.45 years (range 6 months-60 years) had AHP. In total, 24 (80%) of the patients with AHP were aged ≤16 years. The initial complaint in the patients with AHP was ocular misalignment in 18 (60%) patients, AHP in 4 (13.3%), abnormal ocular movements in 4 (13.3%), double vision in 3 (10%), and droopy eyelid in 1 (3.3%). Comitant strabismus, nystagmus, and Duane syndrome were the most common causes of AHP. Other diagnoses included fourth nerve palsy, sixth nerve palsy, Brown syndrome, congenital muscular torticollis, ptosis, and blowout orbital fracture. Conclusions The leading underlying causes of AHP in patients who presented to an ophthalmology clinic were ocular and treatable. Of note, in only a minority of these patients AHP was the initial presenting complaint. Clinicians must be aware that observation of any head position that is not normal should prompt additional investigation, as the underlying pathology can cause treatable morbidity or in rare instances mortality, such as in cases of acute cranial nerve palsy.

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Algorithm for torticollis diagnosis in children of younger age groups

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors79988 ◽

2021 ◽

Vol 9 (4) ◽

pp. 477-490

Author(s):

Yuriy E. Garkavenko ◽

Alexander P. Pozdeev ◽

Irina A. Kriukova

Keyword(s):

Differential Diagnosis ◽

Age Groups ◽

Careful Examination ◽

Older Children ◽

Congenital Muscular Torticollis ◽

Younger Age ◽

Keywords And Phrases ◽

Abnormal Head ◽

Life Threatening ◽

Muscular Torticollis

BACKGROUND: Torticollis is a common term for abnormal head or neck positions. Torticollis can be due to a wide variety of pathological processes, from relatively benign to life-threatening. This syndrome is of particular relevance in pediatric practice and is often underestimated at the primary care level. AIM: To analyze the data of domestic and foreign literature on the etiopathogenesis and clinical features of various types of torticollis in children and develop algorithms for the differential diagnosis of torticollis in children of younger age groups. MATERIALS AND METHODS: A literature search was conducted in the open information databases of eLIBRARY and Pubmed using the keywords and phrases: torticollis, congenital muscular torticollis, non-muscular torticollis, acquired torticollis, and neurogenic torticollis, without limiting the depth of retrospection. RESULTS: Based on the literature data generalization, the classification of torticollis and the key directions of its differential diagnosis are systematized in tabular form. The range of differential diagnosis of torticollis is quite wide and has its characteristics in newborns and children of the first years of life, contrary to older children. The most common is congenital muscular torticollis. Concurrently, non-muscular forms of torticollis in the aggregate are not uncommon, more often with a more serious etiology, and require careful examination. Based on the analyzed literature, differential algorithms for torticollis diagnosis in children of younger age groups have been compiled. CONCLUSIONS: Increasing the level of the knowledge of pediatric clinicians in the etiopathogenesis of torticollis syndrome will improve the efficiency of early diagnosis of dangerous diseases that lead to pathological head and neck positions in children.

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Evaluation of the Clinical Role of Strain Elastography in Patients Diagnosed With Congenital Torticollis

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479320983242 ◽

2021 ◽

pp. 875647932098324

Author(s):

Elif Özyazici Özkan ◽

Mehmet Burak Ozkan ◽

İshak Abdurrahman İsik

Keyword(s):

Area Under The Curve ◽

Muscle Group ◽

Receiver Operating Curve ◽

Control Group ◽

Clinical Role ◽

Congenital Muscular Torticollis ◽

Cutoff Value ◽

Strain Elastography ◽

Specificity And Sensitivity ◽

Muscular Torticollis

Objective: The objective of this study was to determine the elasticity of sternocleidomastoid muscle (SCM) in patients with congenital muscular torticollis (CMT). Methods: In all, 41 patients and 22 controls were included in the study, and the elasticity of the patients’ SCM was measured. Echogenicity, thickness, and strain values of the SCM were also obtained. Results: The thickness and strain values of the SCM were higher in the patient group than in the control group ( P = .02 and P = .15). For median values, there was no difference in echogenicity and strain. In the strain elastography evaluation of the receiver operating curve (ROC) for muscle echogenicity in the isoechoic muscle group, the specificity and sensitivity were determined to be 100% and 22%, respectively, for the area under the curve (AOC) value of 0.558 (95% confidence interval [CI], 0.424–0.6686), and the cutoff value was <1.4. In the hyperechoic muscle group, the ROC for AUC values was found to be 0.542 (95% CI, 0.411–0.6686), and the cutoff value was >1.4 with 100% sensitivity and 20.75 specificity. Conclusions: The strain elastography technique can be used in the diagnosis of CMT.

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Augmented superior rectus muscle transposition in management of defective ocular abduction

BMC Ophthalmology ◽

10.1186/s12886-020-01779-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mohamed F. Farid ◽

Ahmed E. M. Daifalla ◽

Mohamed A. Awwad

Keyword(s):

Nerve Palsy ◽

Rectus Muscle ◽

Muscle Transposition ◽

Primary Position ◽

Superior Rectus ◽

Sixth Nerve Palsy ◽

Abnormal Head ◽

Duane Retraction Syndrome ◽

Sixth Nerve ◽

Superior Rectus Muscle

Abstract Background Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). The aim of the current study is to report the outcomes of augmented SRT in treatment of Eso-DRS and chronic sixth nerve palsy. Methods a retrospective review of medical records of patients with Eso-DRS and complete chronic sixth nerve palsy who were treated by augmented full tendon SRT combined with medial rectus recession (MRc) when intraoperative forced duction test yielded a significant contracture. Effect on primary position esotropia (ET), abnormal head posture (AHP), limitation of ocular ductions as well as complications were reported and analyzed. Results a total of 21 patients were identified: 10 patients with 6th nerve palsy and 11 patients with Eso-DRS. In both groups, SRT was combined with ipsilateral MRc in 18 cases. ET, AHP and limited abduction were improved by means of 33.8PD, 26.5°, and 2.6 units in 6th nerve palsy group and by 31.1PD, 28.6°, and 2 units in Eso-DRS group respectively. Surgical success which was defined as within 10 PD of horizontal orthotropia and within 4 PD of vertical orthotropia was achieved in 15 cases (71.4%). Significant induced hypertropia of more than 4 PD was reported in 3 patients (30%) and in 2 patients (18%) in both groups, respectively. Conclusion augmented SRT with or without MRc is an effective tool for management of ET, AHP and limited abduction secondary to sixth nerve palsy and Eso-DRS. However, this form of augmented superior rectus muscle transposition could result in high rates of induced vertical deviation.

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