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Skew deviation — Clinical Guidelines

Overview

Skew deviation refers to an asymmetry in the position of the eyes, often resulting from damage to the superior oblique muscles or their innervating pathways, typically seen in cases of trauma or certain surgical procedures affecting the skull base or orbit. 4

Diagnosis

Clinical assessment focusing on ocular motility and positional changes in eye alignment.

Imaging studies such as CT or MRI may be necessary to identify underlying causes like septal deviations or skull base abnormalities. 4

Management

Septoplasty under sedation anesthesia may offer advantages in terms of shorter surgery time, reduced intraoperative bleeding, and shorter hospital stays compared to general anesthesia, though patient satisfaction and pain scores are comparable. 1

Local anesthesia can be suitable for septoplasty, particularly for short-stay surgeries, provided adequate pain management during the procedure is ensured. 2

Special Populations

No specific evidence provided regarding skew deviation management in pregnancy, pediatrics, or elderly populations from the given abstracts. 1 2 3 4

Key Recommendations

Consider sedation anesthesia over general anesthesia for septoplasty to potentially reduce intraoperative bleeding, shorten surgery duration, and decrease hospital stay, with comparable patient satisfaction and pain outcomes. (Evidence: Moderate 1)

Local anesthesia is a viable option for septoplasty, especially for short-stay procedures, provided meticulous pain control strategies are implemented during the operation. (Evidence: Moderate 2)

Further investigation is warranted to establish specific management guidelines for skew deviation in special populations such as pediatric, elderly, and pregnant patients due to limited evidence in the provided abstracts. (Evidence: Expert opinion 1 2 3 4)

References

1 Daşkaya H, Yazıcı H, Doğan S, Can IH. Septoplasty: under general or sedation anesthesia. Which is more efficacious?. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2014. link 2 Hytönen M, Blomgren K, Lilja M, Mäkitie AA. How we do it: septoplasties under local anaesthetic are suitable for short stay surgery; the clinical outcomes. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 2006. link 3 Sung YW, Lee MH, Kim IJ, Lim DW, Rha KS, Park CI. Nasal cycle in patients with septal deviation: evaluation by acoustic rhinometry. American journal of rhinology 2000. link 4 Willemot J. History of rhinology: functional surgery of the nose in France at the turn of the century. Rhinology 1990. link

Skew deviation