[Torsional shift operation, a tool in complete early childhood strabismus]

By means of torsional shift operation, or "rotatory Kestenbaum procedure" - in which both ocular bulbs are rotated to the side to which the head is inclined - head malpostures can be eliminated or alleviated in three out of four cases. This applies both to the smaller group of patients with true nystagmus compensation as well as to the large group with "tilt" as a part-symptom of Lang's early-onset strabismus syndrome. The procedure for all four oblique muscles is described in detail, including the strategies for preventing side effects. The results of 98 operations are presented in tabular form. Additionally, the authors describe on the basis of case histories how to apply and modify the procedure when other typical, severe symptoms of early-onset strabismus syndrome require surgical correction. The discussion considers facts and hypotheses relating to the pathophysiological background.