Kestenbaum transposition operation for treatment of the Duane I retraction syndrome

In cases of marked head turn due to Duane's retraction syndrome, abduction ability with a good posture may be obtained by Kestenbaum's muscle transposition. The advantages of this operation are retention of motility with a better distribution of muscular power. At the same time exophoria in the previously favoured direction of gaze is avoided. The degree of transposition must be small (4 to 6 mm) because of the strength of the muscles. In less pronounced cases of head turn the indications for this operation are less obvious. The amount of transposition and the problems caused by the strength of the muscles have to be carefully considered. If strabismus is also present, the operations for squint and for the Duane's retraction should be performed at separate sessions.