Oblique Muscle Surgery for Head Tilt Caused by Congenital Motor Nystagmus

Published on Jan 1, 1996in American Orthoptic Journal
路 DOI :10.1080/0065955X.1996.11982085
Stephen P. Kraft25
Estimated H-index: 25
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: In most instances, a head tilt to either shoulder is caused by hypertropia or cyclotropia and responds well to conventional surgical strengthening or weakening operations on the cyclovertical muscles. Occasionally, an ocular head tilt occurs in the absence of cyclovertical strabismus, in association with congenital nystagmus or without an apparent cause. We have successfully treated four of five such patients by surgically rotating the eye(s) around the sagittal axis. This was accomplished by ...
: The author reports the long-term (average 11 years) results of surgery to correct the face turn or tilt adopted to use the null zone associated with nystagmus. Of the 18 patients 16 had a face turn (7 with fusion and no strabismus, and 9 without fusion and strabismus) and 2 had a head tilt. Surgery was done after the age of 7 years (average 11 years), the same amount of surgery being done on all four horizontal rectus muscles in patients without strabismus to turn the eyes in the same directio...
This paper presents a new technique for weakening the superior oblique muscle by lenghtening the superior oblique tendon by inserting a segment of medical grade silicone 240 retinal band between the cut ends of the tendon. 16 patients (28 eyes) were operated, 14 for superior oblique overaction, and 2 for severe Brown鈥檚 syndrome.
: We report our experience with a procedure involving the transposition and realignment of the vertical recti muscles, in two cases. In the first case, 11 degrees of unilateral excyclotropia was corrected by a one muscle width nasal transposition of the ipsilateral inferior rectus muscle. In the second case, excyclotropia was created in both eyes by a one-half muscle width nasal transposition of both superior recti, and, in a second operation, reversed by a horizontal realignment of these muscle...
: Surgery for a horizontal face turn or tilt in patients with congenital nystagmus began in 1953 and has been modified frequently since then. There are few published reports stating the frequency of or surgical guidelines for the treatment of a vertical or torsional head position due to congenital nystagmus and associated null point. To address this issue a questionnaire was sent to all members of the American Association for Pediatric Ophthalmology and Strabismus. Most respondents see one or tw...
: Records of 32 patients with congenital nystagmus who underwent surgery for a significant head turn were reviewed to assess the effectiveness of current surgical approaches. Eighteen patients (Group I) had single binocular vision and had bilateral recess/resect procedures either according to Parks' 5-6-7-8 scheme (nine patients) or "augmented" from 10% to 40% for large head turns (nine patients). Fourteen (78%) had a reduction of the turn to 15 degrees or less, six (33%) being 5 degrees or less...
鈥 Nystagmus intensities at various gaze angles were studied both preoperatively and postoperatively, using accurate ocular motility recordings, in three cases of congenital nystagmus. In addition to shifting the nystagmus null, the surgery broadened the null region and resulted in an overall reduction in nystagmus intensity at all gaze angles. Surgical rotation also resulted in improved visual acuity in all cases. The postoperative acuity at 0掳 was better than the preoperative acuity at both 0掳 ...
(1973). Congenital Nystagmus Surgery. American Orthoptic Journal: Vol. 23, No. 1, pp. 35-39.
Cited By2
#1Alexander de Castro-Abeger (VUMC: Vanderbilt University Medical Center)H-Index: 1
#2Nancy M. Benegas (VUMC: Vanderbilt University Medical Center)H-Index: 1
Last. Sean P. Donahue (VUMC: Vanderbilt University Medical Center)H-Index: 44
view all 4 authors...
Abstract: Purpose Patients with idiopathic nystagmus syndrome often develop an abnormal head position. A horizontal face turn can be treated with the augmented Kestenbaum procedure, while patients with a chin up or chin down position can be treated with surgery on the vertical recti and/or oblique muscles. Although rare, some patients may have a head tilt with no face turn. We report five patients who underwent horizontal transposition of the vertical rectus muscles to correct a head tilt. Desig...
#1Gregg T. Lueder (WashU: Washington University in St. Louis)H-Index: 23
#2Marlo Galli (WashU: Washington University in St. Louis)H-Index: 4
Background Patients with nystagmus may adopt an abnormal head posture if they have a null zone in eccentric gaze. These patients uncommonly present with torticollis due to a null zone when the head is tilted. We describe the results of surgery on the oblique muscles to improve the abnormal head posture in this condition. Methods This was a retrospective review of patients who had head tilts due to null zones of nystagmus. Surgery consisted of an anterior 50% tenectomy of the superior oblique ten...
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