title: Assessment of extraocular muscles position and anatomy by 3-dimensional ultrasonography: a trial in craniosynostosis patients.
abstract: OBJECTIVE
  To determine whether 3-dimensional ultrasonography (3D US) provides information about anatomy and position of extraocular muscles to better guide surgeons approaching strabismus in patients with craniosynostosis who often have anomalous or absent eye muscles.
  
  
  METHODS
  The 4 rectus eye muscles were imaged using 3D US for 7 children with craniosynostosis before or after strabismus surgery. Reconstructed 3D images were interpreted as having normal or abnormal anatomy and position, based on comparison with images acquired from 6 normal eyes. Interpretation was validated against the intraoperative findings from strabismus surgery.
  
  
  RESULTS
  A total of 34 scans from the study group were used for comparison and validation purposes. Accuracy of anatomical assessments was 85% +/- 12% (percentage +/- confidence interval) and of positional assessments was 62% +/- 16%. Sensitivity and specificity of anatomical assessments was 80% +/- 14% and 88% +/- 10%, respectively. Anatomic anomalies detected by 3D US included excessively thick, thin, scarred and fibrotic, and absent muscles. Sensitivity and specificity of positional assessments was 48% +/- 17% and 85% +/- 12%, respectively. Positional anomalies such as muscle displacement off the normal clock hour axis or posteriorly displaced insertion were also detected.
  
  
  CONCLUSIONS
  The 3D US may have an adjunctive role in determining anatomy and position of rectus muscles in patients with craniosynostosis, although it was more accurate in assessing anatomic features rather than positional features of rectus muscles.
authors.affiliation: Department of Ophthalmology The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sobel
authors.initials: S
authors.lastname: Somani
authors.forename: Leslie D
authors.initials: LD
authors.lastname: Mackeen
authors.forename: Yair
authors.initials: Y
authors.lastname: Morad
authors.forename: J Raymond
authors.initials: JR
authors.lastname: Buncic
authors.forename: Derek C
authors.initials: DC
authors.lastname: Armstrong
authors.forename: John H
authors.initials: JH
authors.lastname: Phillips
authors.forename: Alex V
authors.initials: AV
authors.lastname: Levin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging; D003398:Craniosynostoses / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D005355:Fibrosis; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007432:Intraoperative Period; D008297:Male; D009801:Oculomotor Muscles / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D010865:Pilot Projects; D012680:Sensitivity and Specificity; D013285:Strabismus / Q000601:surgery; D014463:Ultrasonography