Abstract
Purpose::
When patients with congenital nystagmus have a null point and consistent abnormal face turn, the Kestenbaum procedure is a useful technique. Most previous reports describe its use for horizontal face turns. In patients whose null point is in upward/downward gaze and who assume a chin-down/up head position, we have employed a similar procedure on the vertical recti.
Methods::
We retrospectively reviewed the charts of 10 patients with congenital nystagmus who underwent eye muscle surgery to correct a chin down or up head position.
Results::
Eight patients with chin down head position exhibited improved head position following large bilateral superior rectus muscle recessions and large bilateral inferior rectus muscle resections. Two patients with chin up head position underwent successful treatment with a large resection of the superior rectus muscles and large recession of the inferior rectus muscles.
Conclusions::
The Kestenbaum procedure has a goal of shifting a horizontally located null point to primary position. By applying the same principles to the vertical rectus muscles for children having a null position in the vertical plane, we have corrected chin down or up head positions. A modified Kestenbaum procedure on the vertical recti is a useful surgical approach to correct vertical head posturing in patients with null point nystagmus.
Keywords: nystagmus • strabismus: treatment