Kestenbaum surgical procedure for torticollis secondary to congenital nystagmus.

The records of 48 patients with congenital nystagmus who required surgery for a significant head turn were reviewed to compare the effectiveness of the surgical techniques. Patients were omitted from the study if the last postoperative visit was less than five months following surgery, or if the surgery was for a vertical head posture. The average preoperative head turn of the 38 patients with horizontal nystagmus was 41.3 degrees with an average postoperative head turn of 11.5 degrees. The net change in head turn was 33.4 degrees. The average duration of time from surgery to final examination was four years and six months. The study was divided into six groups of patients. The first group received the Parks modification of the standard Kestenbaum procedure, the 5-6-7-8 millimeter procedure. The second group received the above procedure plus 1 mm additional surgery. The third group received another modification by Parks of 6.5-8-9-10 millimeters. The fourth group received the Calhoun and Harley modification of 40% augmentation of the original Parks recommendation, and the fifth group received 60% modification. The sixth group required more than one procedure on the horizontal recti for the abnormal head posture. The pre- and postoperative measurements are compared for each of these six groups. In some patients followed for many years, there is a tendency for a gradual return toward the preoperative head posture. In four patients in the study, the gaze preference was shifted to the opposite direction postoperatively.