THE RESULTS OF SURGICAL TREATMENT OF MUSCULAR TORTICOLLIS IN OLDER CHILDREN

Abstract

Muscular torticollis is rarely seen in our population group. There is controversy regarding the surgical procedure of choice, post operative immobilization and the ultimate results. Several procedures have been described to release the sternocleidomastoid. In children over 5 years correction of secondary deformities are less certain, and complications are scarring and loss of contour of the neck. The aim of this paper is to review the results of bipolar release of the sternocleidomastoid muscle in muscular torticollis.

Between 2000–2006, 3 girls and 1 boy, aged 6–10 years, were treated surgically for muscular torticollis. Spinal abnormalities and other congenital problems were excluded. Through an incision parallel and superior to the clavicle, the sternal and clavicular attachments of the sternocleidomastoid muscle were divided and 2.5cm of muscle was excised. Through a separate transverse incision inferior to the mastoid process, the insertion of the sternomastoid tendon was divided. Post operative traction was used for 5 days, followed by a moulded collar for 3 months.

The children were assessed for function and cosmesis. All scars healed well. The wry neck position improved in all. All children had improvement in movements and cosmesis. There were no visual problems and the lateral band was inconspicuous in the neutral position. Follow up ranged from 1–5 years. Lateral flexion and rotation improved markedly. Two patients reported an increase in height.

Our early results showed that patients over 6 years had marked improvement in cosmesis and movement following bipolar release of muscular torticollis. The improvement in facial asymmetry is being observed with growth. Obviously, the follow up is not long enough to provide adequate long term evaluation. No major complications occurred.