Modified Kestenbaum surgery for correction of abnormal head posture in infantile nystagmus: outcome in 63 patients with graded augmentaton

Abstract

PURPOSE: To analyze the surgical effect of modified Kestenbaum surgery and show how to determine the amount of appropriate augmentation for correction of abnormal head posture in infantile nystagmus. METHODS: We reviewed the records of 63 patients with infantile nystagmus who required surgery for a significant face turn and who were followed for at least five months after surgery. Group 1, consisting of 29 patients, received Parks' modification of the standard Kestenbaum procedure (the 5-6-7-8 mm procedure); Group 2, 32 patients, received a 20% augmentation of the original Parks recommendation; and Group 3, 2 patients, received a 30% augmentation of the original Parks procedure. Pre-and postoperative measurements with electro-oculography (EOG) using Nicolet Compact Four/CA 2000 were made. RESULTS: The average preoperative face turn in the 63 patients with horizontal nystagmus was 31.9 degrees with an average postoperative face turn of 5.2 degrees. The average net change in face turn was 26.7 degrees. The average duration of time from surgery to final examination was thirteen months. Fifty-six out of 63 patients (89%) achieved a straight head position or a residual face turn of 10 degrees or less. CONCLUSION: A Parks' modified Kestenbaum procedure, with appropriate graded augmentation up to 30% is effective for the correction of abnormal head posture in infantile nystagmus without the need for larger augmentations.