Surgery for vertical head position in null point nystagmus

Abstract

Purpose: We applied the general concepts of Anderson and Kestenbaum to the management of patients with chin up or chin down head posture caused by vertical or horizontal nystagmus.

Methods: We reviewed retrospective charts of seven patients with vertical plane torticollis who had surgical management of null point nystagmus.

Results: Three patients with chin down head posture underwent successful treatment using large recessions of the superior rectus muscles combined with inferior oblique muscle anterior transposition. The four patients with chin up head posture were more resistant to surgical treatment. Two of the four required multiple surgical procedures for adequate correction, but had residual torticollis.

Conclusion: Bilateral superior rectus muscle recession combined with inferior oblique muscle anterior transposition is effective surgical management of vertical plane torticollis with chin down head posture caused by null point nystagmus. Although the treatment of patients with chin up head posture was less successful, surgically induced down-gaze deficits may be necessary to improve outcome.