Abstract
Neglected congenital muscular torticollis (CMT) is a common presentation in developing countries like India, with the primary concern of the patients being cosmesis. Little has been published regarding the management of such patients. The aim of our study was to evaluate the results of bipolar release in this age group. Over a period of fiveyears, 14 patients older than tenyears (range 10-19years) with neglected CMT were operated on with bipolar release of sternocleidomastoid muscle and z-plasty lengthening of the sternal end. Postoperative protocol included head halter traction for threeweeks followed by intensive physical therapy. Results were evaluated using a modified version of the system of Lee et al. At an average follow-up of around threeyears (range 1-5years), excellent results were noted in three patients, good in seven, fair in two, and poor in two. Postoperative improvements in range of motion, head tilt, chin deviation and cosmesis were noted in all patients, and these improvements were statistically significant. No surgery-related complications or recurrences requiring surgery occurred in any of the patients. This study concluded that patients with CMT presenting after tenyears of age definitely benefit from surgery, and that bipolar release is an adequate and complication-free method for such patients.
Highlights
Congenital muscular torticollis (CMT) is the third most common congenital musculoskeletal anomaly after dislocation of the hip and clubfoot [1], with a reported incidence of 0.3–1.9% [2, 3]
This study concluded that patients with congenital muscular torticollis (CMT) presenting after ten years of age definitely benefit from surgery, and that bipolar release is an adequate and complication-free method for such patients
Skull and facial asymmetry or plagiocephaly may occur in the presence of prolonged uncorrected head tilt
Summary
Congenital muscular torticollis (CMT) is the third most common congenital musculoskeletal anomaly after dislocation of the hip and clubfoot [1], with a reported incidence of 0.3–1.9% [2, 3]. There seems to be a slight male preponderance of CMT cases, with a relative ratio of approximately 3:2 [4]. The right hand side is more frequently affected [5]. Patients with congenital muscular torticollis present with tilting of the head toward the affected side due to a fibrotic and shortened sternocleidomastoid muscle [1]. Skull and facial asymmetry or plagiocephaly may occur in the presence of prolonged uncorrected head tilt. The characteristic appearance associated with torticollis includes recessed eyebrow and zygoma, deviation of the chin point and nasal tip, inferior orbital dystopia on the affected side, commissural canting toward the affected side, inferiorly and posteriorly positioned ipsilateral ear, and distorted craniofacial skeletal structures [6]
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