Management of neglected cases of congenital muscular torticollis with bipolar release
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20164176Keywords:
Congenital muscular torticollis, Case series, CongenitalAbstract
Background: Congenital muscular torticollis (CMT) is the third most common congenital musculoskeletal anomaly in children. After the age of one year functional and cosmetic benefits require corrective surgery. Neglected congenital torticollis is commoner in developing countries. The purpose of this study was to evaluate the results of bipolar release in this age group.
Methods: 16 cases were operated on for neglected congenital muscular torticollis. Inclusion criteria included age of more than ten years, absence of any previous surgery, and absence of any known pathology. Inferior release was done through an incision 1 cm above the medial third of the clavicle. The clavicular head was released completely while the sternal head was lengthened by z-plasty. The mastoid head was released though an incision just below the tip of the mastoid process. The postoperative management included physiotherapy with halter traction. Neck ROM, head tilt, craniofacial asymmetry were assessed.
Results: Excellent results were noted in four patients, good in eight, fair in two, and poor in two.
Conclusions: We believe that bipolar release is a very viable option for correcting neglected CMT as it brought about both functional improvement as well as improvement in cosmesis, resulting in improved quality of life.
References
Jones CD, Nakhdjevani A, Lidder S. Surgical management of idiopathic torticollis secondary to a fibrotic band. Ortho Rev. 2012;4:27.
Sudesh P, Bali K, Mootha AK, Dhillon MS. Results of bipolar release in the treatment of congenital muscular torticolis in patients older than 10 years of age. J Child Orthop. 2010;4:227–32.
Ballock RT, Song KM. The prevalence of nonmuscular causes of torticollis in children. J Pediatr Orthop. 1996;16:500–4.
Canale ST, Griffin DW, Hubbard CN. Congenital muscular torticollis: a long-term follow-up. J Bone Joint Surg Am. 1982;64:810–6.
Lim KS, Shim JS, Lee YS. Is Sternocleidomastoid Muscle Release Effective in Adults with Neglected Congenital Muscular Torticollis? Clin Orthop Relat Res. 201;472:1271–8.
Cheng JC, Tang SP. Outcome of surgical treatment of congenital muscular torticollis. Clin Orthop Relat Res. 1999;362:190–200.
Ling CM. The influence of age on the results of open sternomastoid tenotomy in muscular torticollis. Clin Orthop Relat Res. 1976;116(5):142–8.
Oh I, Nowacek CJ. Surgical release of congenital torticollis in adults. Clin Orthop Relat Res. 1978;131:141–5.