title: Vertical position of the orbits in nonsyndromic plagiocephaly in childhood and its relation to vertical strabismus.
abstract: OBJECTIVE
  To determine the existence of a correlation between the vertical angle of strabismus and the vertical angle between the orbital axes in nonsyndromic plagiocephaly in childhood.
  
  
  METHODS
  Patients were included when diagnosed with plagiocephaly. Orthoptic measurements showed a vertical strabismus and three-dimensional computed tomographic (CT) imaging of the skull was available. Patients were excluded if plagiocephaly was part of a syndrome or if any surgical intervention had taken place before our measurements. Three-dimensional CT imaging was used to calculate the vertical angle between the orbital axes in 3 reference planes (VAO) perpendicular to a line of reference through the lower borders of the maxilla (VAOmax), both auditory canals (VAOaud), and the lower points of the external occipital protuberances (VAOocc).
  
  
  RESULTS
  Fourteen patients were included (mean age, 14 mo). Three-dimensional CT measurements showed a mean (SD) VAOmax of 1.70 (2.31) degrees, VAOaud of -1.54 (1.46) degrees, and VAOocc of -2.06 (4.29) degrees (a negative value indicates that the eye on the affected side was situated lower in the head). The mean vertical angle of strabismus was -2.39 (4.69) degrees in gaze toward the affected side, 3.66 (3.77) degrees in gaze ahead, and 8.14 (5.63) degrees in gaze toward the nonaffected side. The Pearson test showed no significant correlations.
  
  
  CONCLUSIONS
  The clinical observation that vertical strabismus in adult plagiocephaly is correlated with the vertical angle of the orbital axes could not be confirmed in young children.
authors.affiliation: Department of Ophthalmology, Erasmus MC - Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands. jeveleens@hotmail.com
authors.forename: Jordi R J
authors.initials: JR
authors.lastname: Eveleens
authors.forename: Irene M
authors.initials: IM
authors.lastname: Mathijssen
authors.forename: Maarten H
authors.initials: MH
authors.lastname: Lequin
authors.forename: Jan-Roelof
authors.initials: JR
authors.lastname: Polling
authors.forename: Caspar W N
authors.initials: CW
authors.lastname: Looman
authors.forename: Huibert J
authors.initials: HJ
authors.lastname: Simonsz
mesh_terms: D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D009915:Orbit / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D059041:Plagiocephaly / Q000150:complications* / Q000000981:diagnostic imaging; D013285:Strabismus / Q000209:etiology*; D014057:Tomography, X-Ray Computed