title: Superior rectus muscle recession for residual head tilt after inferior oblique muscle weakening in superior oblique palsy.
abstract: OBJECTIVE
  Residual head tilt has been reported in patients with superior oblique muscle palsy (SOP) after surgery to weaken the inferior oblique (IO) muscle. The treatments for these patients have not received appropriate attention. In this study, we evaluated the superior rectus (SR) muscle recession as a surgical treatment.
  
  
  METHODS
  The medical records of 12 patients with SOP were retrospectively reviewed. Each of these patients had unilateral SR muscle recession for residual head tilt after IO muscle weakening due to SOP. The residual torticollis was classified into three groups on the basis of severity: mild, moderate, or severe. Both IO muscle overaction and vertical deviation, features of SOP, were evaluated in all patients. The severity of the preoperative and postoperative torticollis and vertical deviation were compared using a paired t-test and Fisher's exact test.
  
  
  RESULTS
  The torticollis improved in nine of 12 (75%) patients after SR muscle recession. The difference between the preoperative and postoperative severity of torticollis was statistically significant (p = 0.0008). After surgery, the mean vertical deviation was significantly reduced from 12.4 prism diopters to 1.3 prism diopters (p = 0.0003).
  
  
  CONCLUSIONS
  Unilateral SR muscle recession is an effective method to correct residual head tilt after IO muscle weakening in patients with SOP. This surgical procedure is believed to decrease head tilt by reducing the vertical deviation and thereby the compensatory head tilt.
authors.affiliation: Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Seong Joon
authors.initials: SJ
authors.lastname: Ahn
authors.forename: Jin
authors.initials: J
authors.lastname: Choi
authors.forename: Seong-Joon
authors.initials: SJ
authors.lastname: Kim
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004172:Diplopia / Q000601:surgery*; D005260:Female; D019416:Head Movements; D006801:Humans; D007223:Infant; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery*; D012189:Retrospective Studies; D013285:Strabismus / Q000601:surgery*; D014103:Torticollis / Q000601:surgery*; D016896:Treatment Outcome; D020432:Trochlear Nerve Diseases / Q000601:surgery*