Case history shared with kind permission of the patient.
A 14-year-old patient came into my office to wait while his sister was being treated (Fig 1 a, b). His mother was aware of my interest in posture and suggested that I might look at Mike.
Clearly, there were postural problems. An examination of the face and dentition (Fig 2 a, b) showed an Angle Class 1 occlusion, but neither the family nor Mike were concerned with the mild dental irregularity. When dental models were taken and mounted on an Acculiner articulator the cant of the maxilla up to the right is apparent ( Fig 3). This is confirmed by the p-a radiograph (Fig 4).
He did have occasional lower back discomfort but otherwise appeared to be a healthy, active individual. The only health concern was strabismus, a condition in which there is difficulty in bringing the eyes into focus on the same object.( See Wikipedia). The eyes are out of alignment and there is a tendency for double vision. The brain has to adjust to compensate for this. In a severe case, the brain will suppress the vision from one eye, creating temporary or even permanent blindness although the eye itself is functioning normally. The patient experiences a variety of possible results depending on the body’s ability to adapt and the severity of the condition. The difficulties usually worsen with time if untreated.
What was not anticipated was a steady lessening of the strabismus as the orthodontic treatment progressed. Mike’s ophthalmologist was monitoring him throughout this time and reported an almost complete recovery of normal vision. Mike went on to graduate eventually as an engineer, without experiencing further vision difficulties.
One successful case does not justify the assumption that orthodontic intervention might resolve strabismus. There are far too many variables involved. What it does do is raise questions. One place to start would be to investigate if strabismus patients as a group have a greater tendency to have displacement of the bony orbits when compared to a control group.
Appropriate manipulation by osteopaths in infants has been shown to be effective in correction of various ocular disturbances including strabismus. Even in adults, especially after trauma, such manipulation may resolve the condition. Whether orthodontic intervention might be a means of permanent correction for more severe types of strabismus is a tantalising possibility. Experience with Mike suggests that it would be worth exploring.
* For my journal article with Dr. Strokon on torsion click here.