Correlation between facial asymmetry and laterality of congenital IV cranial nerve palsy at an Ophthalmological Reference Center.Correlation between facial asymmetry and laterality of congenital IV cranial nerve palsy at an Ophthalmological Reference Center.

Abstract

Purpose : To determine is there is a relationship between, degree of facial asymmetry and of laterality of congenital IV nerve palsy (IVNP). All measurements were exclusively obtained by clinical, non-invasive methods, throughout the ohpthalmological physical examination comparing both sides of the face of the patients.

Methods : Descriptive, cross-sectional study. Anthropometric facial measures in millimeters (mm) including oro-canthal distance difference (ΔDOC), palpebral fissure difference (ΔHPH), intercanthal distance (ICD) and strabological examination of patients who attended the Strabismus Department where the diagnosis of congenital IVNP was made during June 2011-June 2013. We reviewed electronic files in order to arrange an appointment for patient’s evaluation. Exclusion criteria: poor patient’s cooperation, palpebral, strabismus or craneofacial surgeries, facial trauma, orbital fracture or facial palsy. The measurements were taken by two observers (intraclass correlation coefficient >0.8). Statistical analysis was performed with Fisher’s exact test, Software Stata MP/12.

Results : 96 patients with IVNP were retrieved. 43 patients (44.8%) were congenital. 24 were enrolled and had a power of 79.23% considered significant (α=0.05 with alternative p=0.7700). Mean age was 7 years (25% percentile 5 years, 75% percentile was 12.8 years). 50% male and 50% female. The laterality of the palsy was: 14 right (58.5%), 6 left (25%) and 4 bilateral cases (16.6%). 20.83% symmetric (5 cases). The prevalence of facial asymmetry was 37.5% (9) mild, 41.67% (10) moderate and no severe asymmetric cases. Congenital IVNP and facial asymetry are associated in 79.17% cases when using ΔDOC

Conclusions : The association between congenital IV nerve palsy and facial asymetry is high (79.17%) compared to general population with a larger distance of the affected side of the face and nerve according to ΔDOC. No correlation was found between ΔDOC and ΔHPH (Rho= 0.0688, p=0.37 Pearson’s X²). The present study demonstrates that facial asymmetry measured by clinical means can be a sign for the ophthalmologist that accompanies IVNP 79.17% of the times and can be used as a clinical clue when diagnosing IVNP or can make the clinician suspect it.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.