Results of bipolar release in the treatment of congenital muscular torticolis in patients older than 10 years of age

Abstract

Purpose 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. Methods Over a period of five years, 14 patients older than ten years (range 10-19 years) 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 three weeks followed by intensive physical therapy. Results were evaluated using a modified version of the system of Lee et al.Results At an average follow-up of around three years (range 1-5 years), 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. Conclusions This study concluded that patients with 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.

Effectiveness of Surgical Treatment for Neglected Congenital Muscular Torticollis

“…1). 8,9,13,17,[44][45][46][47][48][49][50][51] Study characteristics and patient populations are listed in Table 5. All 12 studies analyzed in this review were interrupted time series studies.…”

“…All 12 studies analyzed in this review were interrupted time series studies. Eleven studies were retrospective, 8,9,13,17,44,45,[47][48][49][50][51] and only one 46 was a prospective study. A total of 220 patients with neglected congenital muscular torticollis were included, with 206 patients from the 11 retrospective interrupted time series studies and 14 from the one prospective study.…”

“…Postoperative braces were used in nine of 12 studies 8,9,13,17,45,46,48,50,51 (75 percent), in which cast fixation, 13 a neck splint resembling the halo vest,51 and a cervical collar were used for varying durations. Postoperative neck exercises were used in nine of 12 studies8,9,13,17,[45][46][47][48]51 for varying durations. Two studies44,49 did not use any of the above postoperative programs.…”

Congenital muscular torticollis: Use of gaze angle and translational deformity in assessment of facial asymmetry

“…Long standing or delayed presentation of CMT causes secondary contractures of the platysma muscle, neck muscles and deep fasciae of the neck, resulting in a tilt in ocular gaze, and alteration in facial profile on the affected side 567. Delay in the presentation of neglected CMT is not uncommon in the Indian subcontinent 89. Parents ignore the initial mild neck tilt and seek advice only when the physical deformity is advanced and associated with secondary features such as facial asymmetry (FA) and ocular disturbance.…”

Management of neglected cases of congenital muscular torticollis with bipolar release

“…The right side has a higher preponderance than the left. 2,3 Patients present with tilting of head towards the affected side due to shortening and fibrosis of the sternocleidomastoid. Prolonged head tilt can lead to plagiocephaly.…”