Endoscopic Injection of the Longus Capiti Muscle in the Treatment of Dystonic Head Flexion

Abstract

Background: Anterocollis posture is a relatively rare finding among patients with cervical dystonia and often the cause of treatment failure. The dystonic posture can be complex to analyze, and the deep flexor muscles of the neck, longus capiti, and longus coli can be challenging to access.

Methods: We present a modification of a previously described endoscopic technique that allows straightforward access to the longus capiti muscles in an outpatient setting under local anesthetic.

Results: We describe the technique based on our experience on 6 patients during a 2-year period with a total of 22 injections, and we review the literature.

Conclusion: The injection is well tolerated and has led to significant improvement in the majority of patients.

Keywords: anterocaput; anterocollis; botulinum toxin injection for cervical dystonia; endoscopic injection longus capiti; longus capiti.

Figure 1

Endoscopic view of the postnasal space via right nostril using a 0‐degree telescope. Ridges of hypertrophic LCa muscles seen under the pharyngeal mucosa. EC, Eustacian cushion; EO, Eustacian tube orifice; LCa, longus capiti.

Figure 2

Endoscopic view of the postnasal space with injection needle in the right LCa muscle medial to the EO. EO, Eustacian tube orifice; LCa, longus capiti.