Abstract
Methods A total of 287 consecutive patients diagnosed with congenital SOP and 82 control subjects were included. Congenital SOP patients were grouped according to the presence (present group) or absence (absent group) of the trochlear nerve using thin-section high-resolution MRI of cranial nerves. We developed a computer-aided detection (CAD) system that could automatically analyze objective indices of facial asymmetry using frontal face photographs. Results Of the 287 patients with congenital SOP, 60% of patients had ipsilateral trochlear nerve absence and superior oblique muscle (SO) hypoplasia (absent group), while the remaining 40% had a normal SO and trochlear nerve (present group). All but one objective indices related to facial asymmetry were significantly different between congenital SOP patients and controls (all P < 0.05). Among these features, the angle of nose deviation was significantly larger in the absent group compared to the present group (P < 0.001). Conclusion Objective analysis of facial asymmetry using our novel CAD system was useful for identifying distinct features of congenital SOP. Deviation of the nose was more prominent in congenital SOP patients with trochlear nerve absence.
Highlights
Congenital superior oblique palsy (SOP) is one of the most common causes of ocular torticollis in children, of which the patient tilts his or her head to use both eyes together [1,2,3]
We proposed a computer-aided detection (CAD) system that could automatically analyze objective indices of facial asymmetry. e proposed system consists of two steps: (i) image preprocessing with facial feature extraction and (ii) measurement of each facial asymmetry feature
Among the patients with congenital SOP, 173 (60%) showed ipsilateral absence of the trochlear nerve and superior oblique muscle (SO) hypoplasia, while the remainder (40%) showed symmetric trochlear nerves on both sides. e clinical characteristics of congenital SOP patients and controls are summarized in Table 1. e mean age at examination, gender, cycloplegic refractive error, presence of anisometropia, and amblyopia were not significantly different between the three groups
Summary
Congenital superior oblique palsy (SOP) is one of the most common causes of ocular torticollis in children, of which the patient tilts his or her head to use both eyes together [1,2,3]. Facial asymmetry is progressive if the head tilt persists in young children, and early strabismus surgery to correct the head tilt may help prevent facial asymmetry in congenital SOP [7]. Erefore, successful treatment and prevention of facial asymmetry depend on an accurate diagnosis of the cause and careful monitoring of the degree of facial asymmetry, which may help determine the timing of intervention in patients with congenital SOP [9]. A few attempts have been made to quantify the degree of facial asymmetry objectively using several landmarks of anthropometric measurements on photographs, cephalometric assessment, and with the help of 3-dimensional analysis [2, 4, 9, 10]. There is a risk of radiation using cephalometric radiographs, and optical 3-dimensional surface analysis
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