Functional and Aesthetic Recovery of Congenital Muscular Torticollis with Intramuscular Stromal Vascular Fraction Enriched Fat Grafting

Abstract

Congenital muscular torticollis is a well-known pathological condition caused by the contracture and shortening of the sternocleidomastoid muscle. This condition is manifested by a neck postural deformity often accompanied by some kind of facial asymmetry. Once diagnosed, treatment by early physiotherapy is generally successful in a high percentage of patients if performed during the first year of life. Later, especially after the fourth year, conservative treatment is usually far less effective, and surgical techniques remain the only way to improve neck contour and function. The author reports two cases of adult patients affected by this condition and successfully treated with a novel therapeutic approach consisting of percutaneous myotomies and intramuscular cell-assisted fat grafting.Two cases of adult patients diagnosed with congenital muscular torticollis were analyzed after treatment with percutaneous myotomies and intramuscular fat grafting. The first patient had a history of unsuccessful treatment in infancy with bipolar release of the sternocleidomastoid muscle and was treated with two sessions of fat grafting. The second patient had a history of neglected torticollis and was treated with a single session of cell-assisted fat grafting. In both cases, facial asymmetries were simultaneously treated with the same fat grafting protocol used to treat the muscle. Improvements in muscle function and in face and neck contours were extremely good and stable in both patients. The postoperative course for both patients was uneventful and with a very short and easy recovery when compared with the techniques described to date.Neglected congenital muscular torticollis in adults, or in patients who have not responded adequately to surgical treatment, has been treated safely with percutaneous myotomies and intramuscular fat grafting. The benefit is a scarless technique that provides simultaneous recovery of neck aesthetics and muscle function together with a very short recovery time. Further studies must be conducted to properly evaluate the long-term safety and convenience of cell enrichment to achieve better and long-lasting results.