[Muscular torticollis]

Abstract

Objective: Correction of malalignment of the cervical spine with the head tilted to the side of the shortened muscle and rotation to the opposite side due to a contract sternocleidomastoid muscle. Attainment of an increased range of motion of the cervical spine and a better cosmetic appearance. Regression of a facial asymmetry.

Indications: Contract sternocleidomastoid muscle with deformity intolerable by the patients and their parents.

Contraindications: Bony anomalies with consecutive torticollis. Torticollis caused by other muscular contractures (trapezoid muscle). Torticollis due to acute rheumatoid arthritis or other inflammation around the neck. Other forms of torticollis (psychogenic, ocular, vestibular or spasmodic torticollis).

Surgical technique: In younger children, subcutaneous tenotomy of the distal part of the sternocleidomastoid muscle. At preschool age, additional incision of the deep cervical fascial layer with an open tenotomy. In delayed operations, open distal and proximal tenotomy together with incision of the deep fascial layer or complete excision of the sternocleidomastoid muscle.

Postoperative management: Until the age of 6 years, application of a Minerva cast after surgery for 6 weeks. Subsequently, physical therapy for 6 months. In children of school age and older people, application of a soft cervical bandage for 6 weeks with functional physiotherapy.

Results: In 83 reexamined patients with muscular torticollis, 76 biterminal and seven distal tenotomies had been performed. Regarding the age at the time of operation and the interval to follow-up, an improvement of facial symmetry could be achieved. At the control, 25 patients showed complete recovery of facial asymmetry, 43 had a slight and 15 a severe asymmetry. The complication rate was low with one injury to the external jugular vein and one transient facial nerve paresis. In two patients, passive overcorrection in the cast resulted in transient paresis. Two patients developed a recurrence of muscular torticollis.