Assessing facial asymmetry before and after early treatment of abnormal head posture caused by ocular problems

Clinical relevance Identifying and managing ocular causes of abnormal head posture (AHP) in children is crucial, as early intervention may not only improve visual function but also prevent the development and progression or even resolve facial asymmetry.Background The effect of early AHP treatment on halting the development of facial asymmetry, or even eliminating or decreasing it with age, has not yet been evaluated.Methods In this prospective observational study, the quantitative and qualitative facial asymmetry of paediatric patients with superior oblique palsy (n = 8, 53.3%) and Duane retraction syndrome (n = 7, 46.7%), who had AHP and underwent strabismus surgery, was assessed before and five years after the operation. Captured photographs of the face were analysed by CorelDRAW Graphics Suite X7 software to calculate the relative facial size (RFS) and facial angle as well as evaluate hemihypoplasia, columella deviation, one-side cheek and nostril compression.Results The median preoperative age was 4.5 years (IQR 2.5; range 1–5 years). Preoperative facial asymmetry in 14 (93.3%) patients decreased to 10 (66.7%) postoperatively. On evaluating quantitative facial asymmetry parameters pre- and postoperatively, the median facial angle changed from 0.36° (IQR 1.96°) to 0.00° (IQR 1.37°), and the median RFS changed from 1.006 (IQR 0.031) to 1.000 (IQR 0.019). Before surgery, hemihypoplasia, one-side cheek and nostril compression, and columella deviation were observed in 10 (66.7%), 8 (53.3%), 9 (60.0%), and 2 (13.3%) cases, respectively. Following surgery, there was a reduction of 20.1% in one-side face, 46.6% in cheek, and 46.7% in nostril compression. The frequency of one-side cheek and nostril compression was significantly decreased following surgery (p = 0.011 and p = 0.012, respectively).Conclusion Timely strabismus intervention for the treatment of AHP may help enhance facial symmetry in children. However, as this was an observational study without a control group, a causal relationship cannot be established.