Prognostic Factors in Recurrent Congenital Muscular Torticollis.

Chotigavanichaya C,Wongcharoenwatana J,Kaewpornsawan K,Ariyawatkul T,Eamsobhana P,Phongprapapan P

doi:10.5704/moj.2103.007

Abstract

Introduction:Congenital muscular torticollis (CMT), primarily resulting from unilateral shortening and fibrosis of the sternocleidomastoid muscle. One of the common surgical complications is recurrent deformity. However, the associations between unipolar or bipolar release, age of the patient, and the recurrence of the disease are unclear. Therefore, the purpose of this study was to evaluate the factors associated with recurrence after surgery.Materials and Methods:A retrospective review was performed in 47 patients who were diagnosed with CMT and had been treated surgically with unipolar or bipolar release between January 2007 and December 2015. Demographic data (sex, sides, surgical technique, age at time of surgery, period of follow-up, complications and recurrence) were recorded.Results:Forty-seven patients with an average age of 8.7 years old at time of surgery. Twenty-six patients had right-sided muscular torticollis, while 21 had left-sided. The average follow-up time was 2 years (range, 2–4 years). The average age of unipolar release was 8.8 years old (range, 218 years old), while the average age of bipolar release was 8.7 years old (range, 2–13 years old). Recurrence occurred in 11 patients (9 in unipolar and 2 in bipolar release). Sex, side of deformity, type of surgery and age at time of surgery showed no statistically significant as a factor for recurrence rate, however recurrence of unipolar more than bipolar surgery was nearly two times revealing clinical significance.Conclusions:Sex, side of deformity, type of surgery and age at time of surgery were not associated with the recurrence deformity.

Highlights

Congenital muscular torticollis (CMT), primarily resulting from unilateral shortening and fibrosis of the sternocleidomastoid muscle
Previous literatures suggested causes are compartment syndrome during perinatal period from soft tissue compression of the neck at the time of delivery[4]; intrauterine crowding, based on the high association with breech presentation and developmental dysplasia of the hip[5]; primary neurogenic cause, histopathologic denervation and reinnervation due to a traumatic event[6] and develop fibrosis of the sternocleidomastoid muscle; and the mesenchymal theory[7], which is related to an environmental change, resulting in mesenchymal cells de-differentiating
The purpose of this study was to Corresponding Author: Chatupon Chotigavanichaya, Department of Orthopaedic Surgery, Mahidol University Faculty of Medicine Siriraj Hospital, 2 Thanon Wang Lang, Siri Rat, Bangkok Noi, Bangkok 10700, Thailand Email: chatuponc@gmail.com evaluate the factors associated with recurrence of congenital muscular torticollis after surgery

Summary

Introduction

Congenital muscular torticollis (CMT), primarily resulting from unilateral shortening and fibrosis of the sternocleidomastoid muscle. The associations between unipolar or bipolar release, age of the patient, and the recurrence of the disease are unclear. Demographic data (sex, sides, surgical technique, age at time of surgery, period of follow-up, complications and recurrence) were recorded. Side of deformity, type of surgery and age at time of surgery showed no statistically significant as a factor for recurrence rate, recurrence of unipolar more than bipolar surgery was nearly two times revealing clinical significance. Clinical evidence of torticollis presented initially as a palpable mass or tightness at the involved side; this may be a pseudotumor of the sternocleidomastoid muscle, which causes the cock robin posture[2] Etiology of this disease was still unknown[3]. The purpose of this study was to evaluate the factors associated with recurrence of congenital muscular torticollis after surgery

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