Exotropia Duane Retraction Syndrome and Facial Asymmetry

Quantitative and qualitative evaluation of facial asymmetry in patients with unilateral exotropia Duane retraction syndrome (DRS) with head turn in comparison with normal subjects.

The present cross-sectional study was performed on 22 samples, including 11 patients with unilateral exotropia DRS with a head turn and 11 normal subjects without torticollis as a control group. To evaluate the appearance of the face, from a distance of 40 cm, four photos of each sample were captured and analyzed, using Corel Draw X7 software. The presence of qualitative facial asymmetry parameters, including one-side compression of the nostrils, cheek and face, and columella deviation were recorded. Quantitative facial asymmetry parameters, including "relative face size" and "facial angle" were also measured.

The mean age of patients and normal subjects was 17±10 and 18±10, respectively. Two groups were matched by gender and age (P=0.885, P>0.99, respectively). All 11 (100%) exotropia DRS patients had facial asymmetry, but in the control group, facial asymmetry was observed in 6 (54.5%) subjects, and 5 (45.5%) subjects had perfectly symmetrical faces (P = 0.736). The mean facial angle in the patient group (1.7°±0.016°) was significantly higher than the control group (0.8°± 0.8°) (P= 0.012). Also, the mean relative face size in the patient group (1.022±0.016) was significantly higher than the control group (1.008±1.006) (P = 0.019). The frequency of all qualitative facial asymmetry parameters (one-side compression of the nostrils, cheek and face, and columella deviation) in the patient group was significantly higher than the normal control group (all, P <0.001).

All facial asymmetry parameters in exotropia DRS patients with head turns were significantly higher than the normal control group.