Gosain A K, Steele M A, McCarthy J G, Thorne C H
Institute of Reconstructive Plastic Surgery, NYU Medical Center, USA.
Plast Reconstr Surg. 1996 Apr;97(5):881-91. doi: 10.1097/00006534-199604001-00001.
A prospective study was performed on 16 unoperated patients with frontal plagiocephaly to characterize the relationship between strabismus and abnormal head posture. Serial eye examinations were performed preoperatively and for 24 to 46 months following fronto-orbital advancement. In 14 patients (88 percent), preoperative clinical examination and CT scan indicated coronal plagiocephaly (synostotic); unicoronal synostosis was documented during fronto-orbital advancement in all these patients. Ten patients had abnormal head posture on preoperative examination, 9 of whom had strabismus at some time during the study. These 9 patients all had unicoronal synostosis with ipsilateral strabismus and a contralateral head tilt. All had eye muscle findings consistent with superior oblique paresis, although in 2 patients these signs first developed following fronto-orbital advancement. Strabismus resolved spontaneously in 2 patients between 2 and 8 months following fronto-orbital advancement; the remaining 7 patients underwent extraocular muscle surgery following fronto-orbital advancement, with early resolution of strabismus in all cases. The head tilt resolved or improved significantly in all 9 patients following resolution of the strabismus. Two patients had recurrent superior oblique paresis following surgical correction, necessitating secondary strabismus surgery. The present study indicates that extraocular muscle dysfunction is the major cause of abnormal head posture in patients with coronal plagiocephaly and emphasizes the need for long-term ophthalmologic surveillance in these patients.
对16例未经手术治疗的额部斜头畸形患者进行了一项前瞻性研究，以明确斜视与异常头位之间的关系。术前及额眶前移术后24至46个月进行了系列眼部检查。14例患者（88%）术前临床检查及CT扫描显示为冠状缝早闭性斜头畸形（骨性融合）；所有这些患者在额眶前移术中均证实为单侧冠状缝早闭。10例患者术前检查有异常头位，其中9例在研究期间的某个时间出现斜视。这9例患者均为单侧冠状缝早闭，伴有同侧斜视和对侧头倾。所有患者均有与上斜肌麻痹相符的眼肌表现，尽管其中2例患者这些体征在额眶前移术后才首次出现。2例患者在额眶前移术后2至8个月斜视自行缓解；其余7例患者在额眶前移术后接受了眼外肌手术，所有病例斜视均早期缓解。斜视缓解后，所有9例患者的头倾均得到缓解或明显改善。2例患者手术矫正后出现复发性上斜肌麻痹，需要再次进行斜视手术。本研究表明，眼外肌功能障碍是冠状缝早闭性斜头畸形患者异常头位的主要原因，并强调了对这些患者进行长期眼科监测的必要性。
