Paolo Nucci MDa, Burton J. Kushner MDb, , , Massimiliano Serafino MDa and Nicola Orzalesi MDc
aPediatric Ophthalmology & Strabismus Unit San Paolo Hospital University of Milan, Milan, Italy bDepartment of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin cDepartment of Surgery & Ophthalmology, San Paolo Hospital University of Milan, Milan, Italy.
Purpose To determine the relative frequency that abnormal head postures in children are caused by orthopedic, ophthalmologic, or neurologic disorders, respectively.
Design A prospective, consecutive case series.
Methods Children found to have an abnormal head posture on routine pediatric examination underwent an evaluation by a pediatric ophthalmologist, pediatric orthopedist, and pediatric neurologist. The study was conducted in northwestern Italy.
Results In the 63 children evaluated, the cause of the abnormal head posture was orthopedic in 35, ocular in 25, and neurologic in 5. In 8 patients, no specific cause could be found. The most common orthopedic cause was congenital muscular torticollis, which accounted for 31 patients. The most common ocular cause was superior oblique muscle palsy, which accounted for 12 patients. In 2 patients neck muscle contracture suggested an orthopedic cause, however, the tight neck muscles were secondary to a head tilt caused by superior oblique muscle palsy.
Conclusions When the cause of an abnormal head posture is not obvious, a multi-disciplinary approach including ophthalmologic, neurologic, and orthopedic specialists may be helpful.