I need information on congenital fourth nerve palsy. My eight-month child has a torticollis on the left side. Sometimes, it appears to be worse and other times you hardly notice it. According to some articles, the best time for surgery is when the "facial structure has matured." When is this?

Q. I need information on congenital fourth nerve palsy. My eight-month child has a torticollis on the left side. Sometimes, it appears to be worse and other times you hardly notice it. According to some articles, the best time for surgery is when the "facial structure has matured." When is this?

A.The congenital fourth nerve palsy is a nerve paralysis that moves the eye. Since children are unable to move their eye to the side, they are forced to move their head in the direction. This gives the appearance of having a stiff neck (or torticollis).

The treatment for the congenital fourth nerve palsy is surgery. This is usually done after the first birthday. Some information about congenital fourth nerve palsy is available on a pediatric ophthalmology Web site by doctors from New York at www.pedseye.com.