ABSTRACT
We assessed the efficacy of modified Kestenbaum procedure for the correction of abnormal head position in 16 patients with the diagnosis of in fantile nystagmus. Instead of Parks 5-6-7-8mm modified Kestenbaum procedure, we performed 6-7-6-7mm modified Kestenbaum on 11 patients with head turn of 20-30, 20% augmented procedure(7.2-8.4-7.2-8.4mm) on 4 patients with head turn of 30 or more, and-1mm procedure(5-6-5-6mm) on 1 patent with head turn of less than 20. In the average follow-up of 7 months, 10 patients(62.5%) showed head turn of less than 5, in which 14 of 16 patients had less than10 .87.5% of the patients showed satisfactory correction of abnormal head position., 12 prism diopter of exotropia was noted postoperatively in 1 case but the duction was not limited in any case. From the above results, we conclude that 6-7-6-7mm modified Kestenbaum nystagmus.
Subject(s)
Humans , Diagnosis , Exotropia , Follow-Up Studies , HeadABSTRACT
We performed modified Kestenbaum procedures for correction of abnormal head position in 24 patients with infantile nystagmus. Preoperatively, the degree of head turn ranged from 15 degrees to 45 degrees. For 12 patients with head turn of 15 degrees ~ 30 degrees, 5-6-7-8 modified Kestenbaum procedures were performed. For 9 patients with head turn of 30-40, 20% augmented Kestenbaum procedures were performed and one patient with a 45degree head turn underwent a 30% augmented Kestenbaum procedure. Two patients with vertical chin down underwent 6-7mm recessions of both superior rectus muscles and 5mm resections of both inferior rectus muscles. In the follow-up of an average 12 months, 20 out of 24 patients showed no residual head turn or head turn less than 10 degrees. The modified Kestenbaum procedure could correct the abnormal head position successfully in 83% of infantile nystagmus with one operation. From the above results, we found that the proper amounts of Kestenbaum surgery were 5-6-7-8mm for 25 degrees or less than 25 degrees head turn, 20% augmentation for 30 degrees head turn and 30% or more augmentation for 40 degrees or more head turn.
Subject(s)
Humans , Chin , Follow-Up Studies , Head , MusclesABSTRACT
Twenty patients were operated on under the diagnosis of congenital nystagmus(CN). Of these, nineteen were motor CN and one was sensory CN. Head turning was toward the leftside in 13 patients(65.0%) and the rightside in 7(35.0%). Preoperatively, the degree of head turn ranged from 20 degrees to 45 degrees with a mean of 34.5 degrees. Primarily, modified Kestenbaum procedures were performed and, if necessary, 2nd and/or 3rd operations(Anderson's procedure, Goto's procedure) were performed additionally. The degrees of head turn after the 1st operation ranged from -5 degrees to 30 degrees with a mean of 11.5 degrees. On an average, 23.5 degrees was corrected by 14.8mm of operation on muscles(resection plus recession) for each eye. By these procedures, seventeen patients(85.0%) showed improvement or cure(75% after 1st operation and 10% after 2nd and/or 3rd operation).
Subject(s)
Humans , Diagnosis , Head , Nystagmus, CongenitalABSTRACT
We performed surgery for correction of abnormal head turn in 10 patients with congenital nystagmus. For 3 patients with a head turn of 30 degrees, a 40% augmented modified kestenbaum operation was performed. For 4 patients with a head turn of 45 degrees, a 40% augmented modified kestenbaum operation combined with a 3 - 4 mm recession of conjunctival and subconjunctival tissues was performed. Finally, for 3 patients with a head turn of 60 degrees, a 60% augmented modified kestenbaum procedure combined with a 3 - 4 mm recession of conjunctival and subconjunctival tissues was performed. At the final follow-up visit(averaging 5.9 months), 7 patients showed complete corrections of previous head turn and 3 patients showed a small residual head turn of less than 10 degrees to the same side of the preoperative head turn. The average amount of correction we obtained from the surgery described above were 26.7, 42.5 and 56.7 degrees for the patients who had had a preoperative head turn of 30, 45 and 60 degrees respectively. Among the 10 patients, 4 showed no change in corrected visual acuity, but 6 showed increased corrected visual acuity by over 1 Snellen line. From the above results, we concluded that if recession procedure of the conjunctival and subconjunctival tissues was combined with augmented modified Kestenbaum procedure, its effect for correction of abnormal head turn in a patient with congenital nystagmus could be enhanced.