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PubMed2005

Width of the extended facial recess: a numerical study of ultrahigh-resolution computed tomography and its implications in minimally invasive otologic surgery.

BACKGROUND: Methods of minimally invasive computer-assisted otologic surgery lag behind other fields. The reason seems to be the extremely small dimensions of the corridors between important structures in the temporal bone and the fact that these structures are encased in bony frameworks, are obscured before drilling, and are not movable. The extended facial recess is a surgical pass to the tympanic cavity. It is bounded medially by the facial nerve and laterally by the tympanic annulus, and varies among individuals. For computer-assisted, minimally invasive temporal bone surgery, high-resolution definition is critically important. AIMS: To determine the width of the extended facial recess and evaluate the computerized findings as a pre- and intraoperative aid to otologic surgery planning. METHODS: Bilateral temporal bone high-resolution computed tomographic images of 100 male and 100 female patients were measured twice at five levels (caudal to cephalic), first using a window-independent algorithm (extended facial recess, full-width at half-maximum), implemented in a computed tomographic image-processing workstation, and then manually with calipers on the same axial computed tomographic images. RESULTS: As expected, the extended facial recess, full-width at half-maximum method yielded the widest values superiorly (4.15 +/- 0.41 mm in the female patients and 4.32 +/- 0.54 mm in the male patients). From this level down, the extended facial recess, full-width at half-maximum method yielded values that tapered gradually to 2.50 +/- 0.56 mm in the female patients and 2.42 +/- 0.46 mm in the male patients at the most interior level. The manual method (extended facial recess, computed tomographic images) yielded a significantly higher value than that obtained with the objective, window-independent method at all levels, and at some levels was higher by as much as one-third. At Level 2, which corresponded roughly to the round window, the extended facial recess was 4.00 +/- 0.65 in the female study group and 4.11 +/- 0.67 mm in the male study group. CONCLUSION: Image processing methods such as extended facial recess, full-width at half-maximum method might lead to fine tuning and thus improvement of computer-assisted otologic surgery. Before clinical application and complete dependence on these automated methods during otologic surgery, their reliability should be further validated.

Adolescent↗
PubMed2004

[Hemi-hangback recession (retroposition) of extraocular muscles].

In a small clinical study the author evaluates the efficiency of the hemi-hangback recession (retroposition) procedure. This surgical procedure, which weakens extraocular muscles, proceeds from the hangback recession (retroposition) technique (hanging the muscle on a resorbable suture), which combines with the traditional recession. Hemi-hangback recession procedure is suitable in cases when a recession of more than 7 mm is needed. It is experimentally and clinically as well demonstrated in extra large recessions, that a shift towards the original insertion of the muscle occurs. The combination of the classical and hangback recession has its advantages in specific indications. More convenient surgical access and a reduction of the objectionable shift of the muscle backwards are main advantages of this procedure. The surgical procedure is described in this article and results in the group of patients from the Children's and Adult's Department of Ophthalmology at the Faculty Hospital in Motol, Prague, Czech republic. The hemi-hang-back muscles recession is indicated in third and sixth nerve palsies, restrictive forms of strabismus and complicated or successive forms of strabismus.

Adult↗
PubMed2002

Correlation between mandibular central incisor proclination and gingival recession during fixed appliance therapy.

The purpose of this study was to determine whether proclination of mandibular central incisors during fixed appliance therapy results in gingival recession. Complete records of 67 patients (39 female and 28 male patients; mean age, 16.4 years; age range, 10-45 years) were used in this retrospective case-control study. Using pretreatment and posttreatment lateral cephalograms, the change in mandibular central incisor inclination was measured to divide the patients into an experimental group (proclination) and a control group (no proclination). Changes in clinical crown length were determined from pretreatment and posttreatment study models, and changes in gingival recession were determined from intraoral slides. Eight of the 67 patients exhibited a measurable increase in gingival recession of at least 0.5 mm, and 27 patients had an increase in clinical crown length of at least 0.5 mm. Statistical analyses showed no correlation between mandibular central incisor proclination and gingival recession or clinical crown length. A t-test analysis showed no statistically significant difference in gingival recession or change in clinical crown length between patients whose mandibular central incisors were proclined and those whose incisors were not proclined. Multiple regression analysis demonstrated that age, sex, race, treatment duration, extraction, treatment type, Angle classification, and proclination were not related to gingival recession or change in clinical crown length of mandibular central incisors. We conclude that the degree of proclination of mandibular central incisors during fixed appliance therapy was not correlated to gingival recession in this sample.

Adolescent↗
PubMed1985

Recessive mutations from natural populations of Neurospora crassa that are expressed in the sexual diplophase.

Wild-collected isolates of Neurospora crassa Shear and Dodge were systematically examined for recessive mutations affecting the sexual phase of the life cycle, which is essentially diploid. Seventy-four of 99 wild-collected isolates from 26 populations in the United States, India and Pakistan carried one or more recessive mutations that reduced fertility significantly when homozygous; mutations affecting spore morphology were also detected. Limited complementation tests indicate that most of the 106 recovered mutations are unique.--The recessive diplophase (= sexual phase) mutations were uncovered by crossing each wild-collected isolate to a marked two-chromosome double-reciprocal translocation strain as "balancer." Surviving progeny receive approximately 60% of their genome from the wild parent, but receive the mating-type allele from the "balancer" parent. These progeny were backcrossed to the wild parent and were also crossed with a standard laboratory strain (fl). Reduced fertility in the backcross vs. normal fertility in the cross with the laboratory standard signals the presence of a recessive mutation in the wild-collected isolate.--Most of the mutants (95 of 106) fall into two major classes: those producing barren perithecia with no or few viable ascospores (51) and those with spore maturation defects (44). Most of the recessive barrens result either from an early block in meiosis of ascus development (25) or from a late disturbance in postmeiotic ascus behavior (18).--These recessive mutations are formally equivalent to recessive lethals in higher eukaryotes and may be important in determining the breeding structure of natural Neurospora populations.

Crosses, Genetic↗
PubMed1995

Gingiva thickness in guided tissue regeneration and associated recession at facial furcation defects.

Consistently successful regenerative therapy for furcation defects using membrane techniques remains a challenge for clinicians. The purpose of this study was to determine if the thickness of tissue used to cover the membrane influences postsurgery recession. Thirty-seven (37) moderate to advanced adult periodontitis patients presenting with at least one mandibular or maxillary molar class 1 or 2 facial furcation involvement participated in the study. Mid-facial presurgery recession was recorded from the cemento-enamel junction to the free gingival margin at a reproducible point. Mid-facial tissue thickness was measured using calipers at a point 5 mm apical to the gingival margin of the mucogingival flap reflected at the time of guided tissue regeneration surgery. Patients were divided into 2 groups based upon tissue thickness measurement. Patients were then re-evaluated for recession at 6 months postsurgery. Sixteen (16) patients with tissue thickness < or = 1 mm demonstrated a mean 2.1 mm increase in recession, while 21 patients with tissue thickness > 1 mm exhibited a mean 0.6 mm increase in recession. We conclude that there is less post-treatment recession (P < 0.01) for tissue thickness > 1 mm than tissue thickness < or = 1 mm. Hence, thickness of gingival tissue covering a membrane appears to be a factor to consider if post-treatment recession is to be minimized or avoided.

Adult↗
PubMed1997

Clinical evaluation of tetracycline HCl conditioning in the treatment of gingival recessions. A comparative study.

Thirty Class I and Class II recessions in 30 patients were treated with a modified subepithelial connective tissue graft procedure. Fifteen recessions in the test group received a tetracycline hydrochloride (50 mg/ml) root treatment for 5 minutes (TTC-HCl group); the remaining 15 recessions composed the control group and received a citric acid root treatment for 3 minutes (CA group). Clinical assessments were taken at baseline and at 6 months. The differences between treatments were not statistically significant. In the central area of the recession, the mean percentage of root coverage was 81.7% corresponding to a mean percentage of 79.3% and 84.0% for the TTC-HCl and the CA group, respectively. In the test group, 6 of the 15 recessions exhibited complete root coverage; the gingival augmentation was 57.8%. In the control group, 8 of the 15 recessions exhibited complete root coverage; the gingival augmentation was 43.6%. The mean surface area of root exposure was reduced from 11.53 mm2 and 13.30 mm2 to 0.34 mm2 and 0.29 mm2 for the TTC-HCl group and the CA group, respectively. This reduction corresponds to a mean percentage of 97.4% root coverage for both groups. Within the limits of this study, the results indicate that tetracycline hydrochloride and citric acid root conditioning have comparable clinical effects in root coverage surgical therapy. The data also suggest that the measurement of the surface area of the recession is a more accurate criterion in the evaluation of the mean percentage of root coverage than a single central vertical linear measurement.

Administration, Topical↗
PubMed2001

Comparative 6-month clinical study of a subepithelial connective tissue graft and acellular dermal matrix graft for the treatment of gingival recession.

BACKGROUND: Different techniques have been proposed for the treatment of gingival recessions. This study compared the clinical results of gingival recession treatment using a subepithelial connective tissue graft and an acellular dermal matrix allograft. METHODS: Nine patients with bilateral Miller Class I or II gingival recessions were selected. A total of 30 recessions were treated and randomly assigned to the test group and the contralateral recession to the control group. In the control group, the exposed root surfaces were treated by the placement of a connective tissue graft in combination with a coronally positioned flap; in the test group, an acellular dermal matrix allograft was used as a substitute for palatal donor tissue. Probing depth, clinical attachment level, gingival recession, and width of keratinized tissue were measured 2 weeks prior to surgery and 3 and 6 months postsurgery. RESULTS: There were no statistically significant differences between the test group and the control group in terms of recession reduction, clinical attachment gain, and reduction in probing depth. The control group had a statistically significant increased area of keratinized tissue after 3 months compared to the test group. Both procedures, however, produced an increase in keratinized tissue after 6 months, with no statistically significant difference. CONCLUSION: The acellular dermal matrix allograft may be a substitute for palatal donor tissue in root coverage procedures.

Adult↗
PubMed2004

Treatment of gingival recession using a collagen membrane with or without the use of demineralized freeze-dried bone allograft for space maintenance.

BACKGROUND: Studies utilizing collagen membranes for guided tissue regeneration (GTR)-based root coverage procedures have reported promising results. However, creating and maintaining space underneath the membrane remains a challenge. Therefore, the purpose of this clinical trial was to determine whether the addition of bone graft (i.e., demineralized freeze-dried bone allograft [DFDBA]) significantly affects the outcome of collagen membrane GTR-based root coverage procedures. METHODS: Twenty patients participated. One Miller's Class I or II recession defect per patient was treated with a collagen membrane covered by a coronally positioned flap. Half of the patients also had DFDBA placed under the membrane. Clinical parameters recorded included: recession depth, recession width, width of keratinized tissue, clinical attachment level, and probing depth, measured to the nearest 0.5 mm. Presurgery and postsurgery (6-month) data were compared using Student's paired t test for parametric data and the Wilcoxon matched pairs test for non-parametric data. RESULTS: Guided tissue regeneration with collagen (COLL) and collagen + DFDBA (COBA) both resulted in statistically significant (P <0.05) reductions in recession depth (2.1 +/- 0.9 mm and 2.5 +/- 0.5 mm), recession width (1.5 +/- 1.7 mm and 2.2 +/- 1.6 mm), increase in keratinized tissue (0.7 +/- 0.8 mm and 1.2 +/- 1.0 mm), and gain of clinical attachment level (2.1 +/- 1.0 mm and 3.0 +/- 1.0 mm), when comparing 6-month data to baseline. Mean root coverage was 68.4 +/- 15.2% with COLL and 74.3 +/- 11.7% with COBA. However, there were no statistically significant differences between groups for recession depth, recession width, width of keratinized tissue, clinical attachment level, and probing depth. CONCLUSIONS: Both techniques are effective in attaining root coverage. Although root coverage tended to be better with the addition of DFDBA, the difference was not statistically significant. Further studies with a larger sample size are needed to determine whether adding DFDBA to GTR-based procedures using collagen membranes is of any benefit.

Adult↗
PubMed2004

Coronally positioned flap with or without acellular dermal matrix graft in the treatment of Class I gingival recessions: a randomized controlled clinical study.

BACKGROUND: The aim of this study was to clinically evaluate the treatment of Class I gingival recessions by coronally positioned flap with or without acellular dermal matrix allograft (ADM). METHODS: Thirteen patients with comparable bilateral Miller Class I gingival recessions (> or = 3.0 mm) were selected. The defects were randomly assigned to one of the treatments: coronally positioned flap and acellular dermal matrix (ADM group) or coronally positioned flap alone (CPF group). The clinical parameters included: probing depth (PD), clinical attachment level (CAL), recession height (RH), recession width (RW), height of keratinized tissue (HKT), thickness of keratinized tissue (TKT), plaque index (PI), and gingival index (GI). The measurements were taken before the surgeries and after 6 months. RESULTS: The mean baseline recession was 3.4 mm and 3.5 mm for ADM group and CPF group, respectively. After 6 months, both treatments resulted in significant root coverage (P < 0.01), reaching an average of 2.6 mm (76%) in the ADM group and 2.5 mm (71%) in the CPF group. The difference in recession reduction between treatments was not statistically significant. There were no statistically significant differences between the treatments in PD, CAL, RH, RW, and HKT. However, the mean TKT gain was 0.7 mm for the ADM group and 0.2 mm for the CPF group (P < 0.01). CONCLUSION: It can be concluded that both techniques could provide significant root coverage in Class I gingival recessions; however, a greater keratinized tissue thickness can be expected with ADM.

Adult↗
PubMed2005

Coverage of Miller class I and II recession defects using enamel matrix proteins versus coronally advanced flap technique: a 2-year report.

BACKGROUND: The aim of this study was to evaluate a comparison of the coronally advanced flap procedure with or without the use of enamel matrix proteins in the treatment of recession defects. METHODS: This 2-year study was conducted as a blinded, split-mouth, placebo-controlled, and randomized design. Thirty patients from two dental schools with two paired buccal recession defects were chosen. Surgical recession coverage was performed as the coronally advanced flap technique. One site was additionally treated with derivative (EMD) and the other site with a placebo (propylene glycol alginate [PGA]). A blinded examiner assessed pre- and post-surgical measurements. Measurements comprised the height and width of the gingival recession, height of keratinized tissue, probing attachment level, probing depth, and alveolar bone level. RESULTS: Twenty-four months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. The mean gingival recession decreased from 3.6 to 0.8 mm for the EMD-treated sites and from 3.8 to 1.4 mm for the control sites. However, this difference was not statistically significant (P = 0.122). Similarly, all other clinical parameters did not differ significantly in the between-group comparison except for the recession width (P = 0.027) and probing depth (P = 0.046) exhibiting higher reductions in the EMD group. Complete root coverage could be maintained over 2 years in 53% of the EMD versus merely 23% in the control group. A total of 47% of the treated recessions in the control group deteriorated again in the second year after therapy compared to 22% in the EMD group. CONCLUSION: Enamel matrix derivative seems to provide better long-term results.

Adult↗
PubMed1982

Further studies on the effect of the recessive white genotype on early growth rate and body size.

Previous studies from this laboratory have demonstrated a relationship between the C+ and c alleles at the recessive white locus and body weight at 8 and 26 weeks of age. Similar studies have been conducted on the same randombred population 20 and 21 generations later. In addition, one experiment involved a comparison of colored and recessive white birds when grown on a low energy replacement starter vs. a high energy broiler starter. The 1981 progeny studied were produced by 100 females housed in single bird cages and inseminated with pooled semen from 20 males. The gene frequency for the recessive white gene (c) was .56 +/- .023 and the recessive white segregates were approximately 35% of the progeny produced. The 8-week body weights of the recessive white progeny as a percentage of the colored phenotype (C+/-) was 88.8% for males and 92.5% for females. These body weight differences at 8 weeks were highly significant (P less than .005). The recessive white genotype also reduced 26-week body weight of females and 38-week egg weight. As expected, there were highly significant differences (P less than .001) in body weight at 4, 6, and 8 weeks of age due to rations. However, there was no evidence of a genotype X ration interaction. The observed differences between genotypes (C+/- vs. c/c) were similar regardless of the energy level of the ration. These results confirm and extend the earlier observations on the depressing effect of the recessive white genotype on early growth and support the conclusion that this relationship represents a pleiotropic effect of the gene and is not the result of linkage disequilibrium.

Animals↗
PubMed2004

[Treatment of gingival recessions of teeth with ceramic full crown by autogenous connective tissue graft].

PURPOSE: The aim of this clinical study was to evaluate gingival recession of teeth with ceramic full crown treated with subepithelial connective tissue grafts. METHODS: In 20 systemically healthy, whose ages ranging from 31 to 58 years, 32 teeth with ceramic full crown developed gingival recession. Selection of gingival recession defects was based upon the following criteria: A minimum of 2 mm of root surface exposure in coronal-apical height. Miller class I and II recession. Interproximal and labial probing depth </=4 mm. No active caries or restorations on the tooth surfaces. Gingival recession were treated with subepithelial connective tissue grafts technique. RESULTS: The results indicated that subepithelial connective tissue grafts increased the height of gingival recession (GR) and gingival thickness (GT), the mean percentage of root coverage (RC) was 85.1%. CONCLUSION: These results suggest that subepithelial connective tissue grafts were able to successfully treat gingival recession defects. Moreover, the results has significant clinical benefit for aesthetics and treatment outcomes.

Adult↗
PubMed2006

Comparative clinical evaluation of acellular dermal matrix allograft and connective tissue graft for the treatment of gingival recession.

AIMS: "Gingival recession is a condition reported to occur due to abnormal periodontal anatomy, poor hygiene, excessive occlusal forces, toothbrush abrasion, and even iatrogenic or factitious causes. Though various surgical techniques are available to treat this problem, the most common is the palatal soft tissue autograft. Recently, an acellular dermal matrix allograft (ADMA) has been available as a substitute for the palatal tissue harvest. The aim of this study is to compare the ADMA with the conventional subepithelial connective tissue graft (SCTG) in the treatment of gingival recession." METHODS AND MATERIALS: Fourteen patients with 20 gingival recessions of Miller's grade I and II were selected and randomized in two groups of control (SCTG ) and test (ADMA). In each group ten recession defects were treated. The following parameters were measured at baseline and then at six months post surgery: recession height (RH), recession width (RW), probing depth (PD), attached gingiva (AG), keratinized gingiva (KG), and clinical attachment level (CAL). All parameters were analyzed using the two-sample t-test. Data analysis was performed using SPSS (version 11) software. RESULTS: The following mean changes (mm) occurred in SCTG and ADMA, respectively: 2.60+/-0.97 and 2.90+/-0.81 decrease in RH; 1.70+/-1.01 and 1.65+/-0.67 decrease in RW; 2.50+/-0.97 and 2.95+/-0.69 increase in KG; 2.25+/-0.92 and 2.65+/-0.85 increase in AG; 2.60+/-1.08 and 2.75+/-0.92 decrease in CAL; and finally 0.05+/-0.50 and 0.10+/-0.46 decrease in PD for the SCTG and ADMA groups, respectively. The percentage of root coverage for the two groups was 70.12%+/-22.81% and 72.08%+/-14.12%, respectively. The changes from baseline to the six-month visit were significant for both groups in terms of all parameters but PD. However, the differences in mean changes were not significant between the two groups in any of the parameters. CONCLUSION: These findings imply the ADMA and SCTG techniques could produce the same results when used for the successful treatment of gingival recessions. In addition the ADMA could be used as an adequate alternative treatment modality for conventional techniques.

Adult↗
PubMed1991

The association between supragingival [correction of subgingival] calculus deposits and the extent of gingival recession in a sample of Thai children and teenagers.

A survey was performed on a sample of children and teenagers in Thailand. The sample consisted of 260 subjects ages 10-17 years. Assessments of the prevalence and amount of supragingival calculus (Volpe-Manhold) on the facial and lingual surfaces of the six mandibular anterior teeth were recorded. All subjects then received a thorough whole mouth prophylaxis. Two weeks later they were reexamined for gingival recession using the Gingival Recession Total (GRT) scoring system on the same six mandibular anterior teeth. For the analysis, the calculus scores were used to categorize the subjects as having slight, medium, or heavy calculus. Using the GRT scores, the same subjects were then categorized as having mild, moderate or extensive gingival recession. The categories of both calculus level and gingival recession level were statistically assessed using the Chi-square distribution and a significant difference was found indicating that the amount of calculus was related to total gingival recession. Subjects with slight calculus had more mild recession whereas medium or heavy calculus formers had more moderate or extensive total gingival recession scores.

Adolescent↗
PubMed1991

[Treatment of gingival recession with a coronally repositioned flap].

The treatment of an exposed root surface may be indicated for an aesthetic improvement of a gingival recession. The surgical technic depends on the type of the recession, the quality and the quantity of the keratinized gingiva apically or laterally from the recession. The purpose of this study is to evaluate the minimal quantity of keratinized gingiva necessary to obtain a root coverage. 10 recessions on maxillary cuspids were treated with coronally repositioned flap. Less than 3 mm of keratinized gingiva was present apically to the exposed root surface. All patients received oral hygiene instructions, plaque control and scaling and root planing. Gingival recession, width of keratinized gingiva and loss of attachment were measured at the time of surgery and three months postoperatively. The mean recession was 5.20 mm (+/- SE = 0.36) prior to treatment and the keratinized gingiva was 1.70 mm (+/- 0.16) high at T0. The mean gain of root coverage was 3.43 mm (+/- 0.29) at three months post-operatively. At T0 and 3 months post-operatively, the measures of recessions showed a statistically difference confirming the validity of the technic. The absence of correlation between initial height of keratinized gingiva and the coverage result (r = 0.05) indicates that initial width of keratinized gingiva does not affect the coverage results.

Epithelial Attachment↗
PubMed1991

Grafted and ungrafted labial gingival recession in pediatric orthodontic patients: effects of retraction and inflammation.

The purpose of this retrospective study was to determine changes in recession and other periodontal factors after orthodontic treatment of malocclusions. Twenty patients with preorthodontic labial recession on one or more mandibular central incisors were studied. Ten patients had received autogenous gingival grafts in the area of recession prior to orthodontics, while ten received no graft. The teeth presenting recession had been retruded from a preorthodontically prominent arch position. Moderate inflammation of marginal tissues and fair-to-poor oral hygiene were maintained by the patients. Statistically significantly less gingival recession was found in both groups after orthodontic treatment than was found pretreatment. The results of this study indicated that labial recession tends to decrease with retrusion of mandibular incisors even when moderate inflammation and fair-to-poor oral hygiene persist. Preorthodontic gingival grafting did not further decrease the postorthodontic gingival recession.

Adolescent↗
PubMed1986

Cross-sectional anatomy of the pericardial sinuses, recesses, and adjacent structures.

Detailed drawings of four cross sections through the mediastinum which pass through the sinuses and recesses of the pericardial cavity, are presented. The drawings depict the location and extent of the pericardial sinuses, recesses, and their closely associated extrapericardial structures. Two previously unnamed recesses within the serous pericardium are defined and named, one the inferior aortic recess of the transverse sinus and the other, the right pulmonic recess of the transverse sinus. The terminology of the pericardial sinuses and recesses has been inconsistent, and the authors propose a nomenclature for standardizing the names of the recesses of the serous pericardium. Important anatomic pericardial relationships with regard to pericardial effusions and lymphadenopathy are discussed.

Diagnosis, Differential↗
PubMed1998

Comparison of anterior transposition and recession of the inferior oblique muscle in unilateral superior oblique paresis.

PURPOSE: Both anterior transposition and graded recession have been shown to be effective procedures in weakening the inferior oblique muscle. Anterior transposition may work in part by converting the inferior oblique muscle from an elevator to a depressor of the globe. In theory, this would be useful in treating the inferior oblique overaction associated with superior oblique paresis. We compared inferior oblique recession and anterior transposition for the surgical correction of Knapp's class III unilateral superior oblique paresis. METHODS: Four patients underwent 14 mm recession, and five underwent anterior transposition of the inferior oblique muscle for the hypertropia in superior oblique paresis. Prism cover test measurements were made in all cardinal fields of gaze and were compared before and after operation between the two groups. RESULTS: The mean preoperative hyperdeviation in the primary position was 12 prism diopters in the recession group and 15 prism diopters in the anterior transposition group. The mean postoperative hyperdeviation was 1 prism diopter in the recession group and 3 prism diopters in the anterior transposition group. Postoperative results in the inferior oblique field of action demonstrated a mean 3 prism diopter hypertropia in the recession group and a 2 prism diopter hypotropia in the anterior transposition group. CONCLUSIONS: Anterior transposition and graded recession gave similar results in correcting the primary position hyperdeviation in Knapp's class III superior oblique paresis. Both procedures also markedly improved the hyperdeviation in the field of action of the inferior oblique muscle and superior oblique muscle. However, anterior transposition was more likely to result in postoperative hypodeviation in upgaze.

Adult↗