Journal of pediatric ophthalmology and strabismus · 2025
Impact of Long-term Abnormal Head Position on Carotid Artery Flow in Congenital Fourth Nerve Palsy.
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Aydın Fahri Onur, Çelen Arabacı İdil, Arslan Fatma Zeynep, Savur Fatma, Öğreden Tülin, Kaldırım Havva
Аннотация
PURPOSE: To investigate the impact of long-term abnormal head position on internal carotid artery (ICA) and external carotid artery (ECA) flow patterns in patients with unilateral congenital fourth nerve palsy.
METHODS: This study was conducted in a tertiary clinic and involved 29 patients with congenital fourth cranial nerve palsy, with a vertical deviation greater than 14 prism diopters. Demographic information, clinical presentations, and ophthalmological findings were reviewed, and carotid Doppler ultrasound measurements were compared.
RESULTS: The mean age of the patients was 21.4 ± 10.9 years, with 16 females and 13 males included in the study. The vertical deviation of the cases ranged from 14 to 35 prism diopters (PD), with a median deviation of 22 PD. ECA and ICA diameters were significantly lower on the non-paralytic side compared to the paralytic side (P = .001 and .008), whereas resistive index values were higher on the non-paralytic side (P = .009 and .011). A strong positive correlation was found between the angle of deviation and age (r = 0.685, P < .001), and a negative correlation was noted between carotid flow velocities and angle of deviation (r = -0.546 to -0.626, P < .001).
CONCLUSIONS: In patients with congenital fourth nerve palsy, long-term abnormal head position may alter carotid artery flow, reducing vessel diameter, and increasing resistive index on the non-paralytic side. These changes may contribute to complications, suggesting that timely surgical intervention might help prevent carotid flow alterations, facial asymmetry, and musculoskeletal issues.
METHODS: This study was conducted in a tertiary clinic and involved 29 patients with congenital fourth cranial nerve palsy, with a vertical deviation greater than 14 prism diopters. Demographic information, clinical presentations, and ophthalmological findings were reviewed, and carotid Doppler ultrasound measurements were compared.
RESULTS: The mean age of the patients was 21.4 ± 10.9 years, with 16 females and 13 males included in the study. The vertical deviation of the cases ranged from 14 to 35 prism diopters (PD), with a median deviation of 22 PD. ECA and ICA diameters were significantly lower on the non-paralytic side compared to the paralytic side (P = .001 and .008), whereas resistive index values were higher on the non-paralytic side (P = .009 and .011). A strong positive correlation was found between the angle of deviation and age (r = 0.685, P < .001), and a negative correlation was noted between carotid flow velocities and angle of deviation (r = -0.546 to -0.626, P < .001).
CONCLUSIONS: In patients with congenital fourth nerve palsy, long-term abnormal head position may alter carotid artery flow, reducing vessel diameter, and increasing resistive index on the non-paralytic side. These changes may contribute to complications, suggesting that timely surgical intervention might help prevent carotid flow alterations, facial asymmetry, and musculoskeletal issues.