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Extraocular muscle positions in anterior plagiocephaly: V-pattern strabismus explained using geometric mophometrics
  1. Romain Touzé1,
  2. Yann Heuzé2,
  3. Matthieu P. Robert1,3,
  4. Dominique Brémond-Gignac1,
  5. Charles-Joris Roux4,
  6. Syril James5,6,
  7. Giovanna Paternoster5,
  8. Eric Arnaud5,6,
  9. Roman Hossein Khonsari5,7
  1. 1Department of Ophthalmology, Hôpital Universitaire Necker – Enfants Malades, Assistance Publique – Hôpitaux de Paris; Université de Paris, Sorbonne Paris Cité, Paris, France
  2. 2CRNS, Université de Bordeaux, MCC, PACEA, UMR5199, Pessac, France
  3. 3COGNAC-G, UMR 8257, CNRS-SSA-Université de Paris, Paris, France
  4. 4Department of Pediatric Radiology, Hôpital Universitaire Necker – Enfants Malades, Assistance Publique – Hôpitaux de Paris; Université de Paris, Sorbonne Paris Cité, Paris, France
  5. 5Department of Neurosurgery, Craniofacial surgery unit, Hôpital Universitaire Necker – Enfants Malades, Assistance Publique – Hôpitaux de Paris; Centre de Référence des Malformations Craniofaciale CRANIOST, Filière Maladies Rares TeteCou; Université Paris Descartes, Université de Paris, Paris, France
  6. 6Department of Neurosurgery, Clinique Marcel Sembat, Boulogne-Billancourt, France
  7. 7Department of Maxillo-Facial Surgery and Plastic Surgery, Hôpital Universitaire Necker – Enfants Malades, Assistance Publique – Hôpitaux de Paris; Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou; Université Paris Descartes, Université de Paris, Paris, France
  1. Correspondence to Dr Romain Touzé, Ophthalmology, Hopital Necker-Enfants Malades, Paris, France; r.touze.rt{at}gmail.com

Abstract

Introduction Ophthalmological involvement in anterior plagiocephaly (AP) due to unicoronal synostosis (UCS) raises management challenges. Two abnormalities of the extraocular muscles (EOM) are commonly reported in UCS without objective quantification: (1) excyclorotation of the eye and (2) malposition of the trochlea of the superior oblique muscle. Here we aimed to assess the positions of the EOM in AP, using geometric morphometrics based on MRI data.

Materials and methods Patient files were listed using Dr WareHouse, a dedicated big data search engine. We included all patients with AP managed between 2013 and 2018, with an available digital preoperative MRI. MRIs from age-matched controls without craniofacial conditions were also included. We defined 13 orbital and skull base landmarks in order to model the 3D position of the EOM. Cephalometric analyses and geometric morphometrics with Procrustes superimposition and principal component analysis were used with the aim of defining specific EOM anomalies in UCS.

Results We included 15 preoperative and 7 postoperative MRIs from patients with UCS and 24 MRIs from age-matched controls. Cephalometric analyses, Procrustes superimposition and distance computations showed a significant shape difference for the position of the trochlea of the superior oblique muscle and an excyclorotation of the EOM.

Conclusions Our results confirm that UCS-associated anomalies of the superior oblique muscle function are associated with malposition of its trochlea in the roof of the orbit. This clinical anomaly supports the importance of MRI imaging in the surgical management of strabismus in patients with UCS.

  • child health (paediatrics)
  • imaging
  • muscles
  • orbit
  • treatment surgery
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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Patients were informed of the use of their medical data for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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