Surgery for nystagmus related head turn: Kestenbaum procedure and artificial divergence

Abstract

Artificial divergence is preferable or should be combined with Kestenbaum surgery, if possible. Kestenbaum surgery alone has an effect/dose ratio similar to recess-resect surgery for strabismus. Thus, to correct x degrees HT, 2/3x mm surgery on each eye is adequate.

A Prospective Clinical Evaluation of Augmented Anderson Procedure for Idiopathic Infantile Nystagmus

“…6 Surgery is usually not done prior to 6 years because a spontaneous decrease in head turn is possible. 7,8 This was corroborated by many of our patients who reported that initially the face turn was larger and gradually has improved to the present level. There is also possible variability in the face turn.…”

Kestenbaum procedure on the vertical rectus muscles with simultaneous compensation of the induced cyclodeviation for nystagmus patients with chin-up or chin-down head posture

“…Thus, after compensation of the cyclodeviation, the surgery on the oblique muscles has an additional positive effect on the head posture and increases the Kestenbaum effect. This might explain why good reduction of the head posture was reached with less surgery than reported in previous studies given on vertical and horizontal procedures [4,5,17]. So simultaneous procedures on the oblique muscles not only compensate for cyclodeviation, but the intended effect on head posture is also increased so that dosage of surgery on the vertical recti might be kept relatively low to prevent adverse side-effects.…”

“…Because of the high rates of recurrence and undercorrection, the dosages suggested by Parks were augmented by either 40% for patients with head turn of 30°, resulting in surgery of 7 mm, 8.4 mm, 9.8 mm, and 11.2 mm on the rectus muscles, or 60% for patients with head turn of 45°, which results in surgery of 8 mm, 9.6 mm, 11.2 mm and 12.8 mm. Recently, larger studies, for example by Gräf et al [4,5] confirmed the need for higher dosages for the correction of an abnormal horizontal head posture. Gräf et al concluded that surgery in mm on each eye should be two-thirds of the horizontal head turn in degrees, i.e.…”

Methods of Measurement and Evaluation of Eye, Head and Shoulders Position in Neurological Practice

“…The dosage of ocular muscle retroposition/resection depends on the angle of AHP with fixation of distant target. The reduction of abnormal head turn with 1mm muscle resection was 1.4˚ head turn on average in one study (Gräf et al, 2001). …”