SHOULD EARLY STRABISMUS SURGERY BE PERFORMED FOR OCULAR TORTICOLLIS TO PREVENT FACIAL ASYMMETRY

To help determine whether ocular torticollis causes facial asymmetry, we analyzed photographs of patients with long-standing head tilts for amounts of tilt and facial asymmetry. Significant facial asymmetry tha t correlated with the side of the head tilt was found in patients with congenital superior oblique muscle paresis, but not in patients with traumatic superior oblique muscle paresis nor in patients with dissoci ated vertical deviation. The mechanism explaining the development of f acial asymmetry in these patients may be deformational molding of the face and skull from the infant's sleeping with its head turned predomi nantly to one side during the first 6 to 12 months of life. Early stra bismus surgery to correct the head tilt may help prevent facial asymme try, but ensuring that the infant sleeps with alternating head positio ns may be more important.