Surgery for Vertical Abnormal Head Posture in Infantile Nystagmus

PURPOSE: The purpose of this study is to assess the effect of surgical management for infantile nystagmus with vertical abnormal head posture. METHODS: We performed surgical procedures to correct the vertical abnormal head posture of more than 10degrees in 6 patients with infantile nystagmus. One patient with the chin-up head posture was treated with recession of bilateral inferior rectus muscles and resection of bilateral superior rectus muscles, and 5 patients with the chin-down head posture were treated with recession of bilateral superior rectus muscles and resection of bilateral inferior rectus muscles. The pre- and post-operative measurements of the head posture were evaluated and compared with each other. RESULTS: Preoperatively, the degree of vertical head posture ranged from 10 to 30degrees, and 4 patients were with the 20~30degrees abnormal head posture. In the average follow-up period of 35.8 months, 5 patients (83.3%) showed less than 5degrees of chin-up or chin-down head posture. In one case, 20degrees left face turn was noted postoperatively. However, duction was full in all cases. CONCLUSIONS: These results suggest that the surgical management with bilateral vertical rectus muscles was effective for the correction of vertical abnormal head posture in infantile nystagmus.

Clinical Manifestation of Abnormal heal Posture

Medical records of one hundred tow patients with abnormal head posture who were seen at our clinic between 1994 and 1997 were reviewed. The mean age was 7.8 years and the abnormal head posture was detected at 2.1 years. Thirty-two of the patients were female and 70 were male. There were 65 cases with face turn, 19 with head tilt, 6 with chin up or down, 7 with combined head posture and 5 with head nodding. In etiologic aspect, there were 60 cases with infantile nystagmus, 18 with paralytic strabismus, 13 with horizontal or vertical strabismus, 5 with Duane`s retraction syndrome and 6 with the others. Infantile nystagmus was the most common etiology of face turn and paralytic strabismus was that of head tilt. Thirty-three among 38 patients who had surgical procedure showed improvement in head posture.