Sternomastoid Tumour and Muscular Torticollis

Abstract

1. A parallel study has been made of fifty patients presenting with a sternomastoid tumour and fifty-two patients presenting with muscular torticollis. 2. In the birth histories of both these groups there was a high incidence of breech, forceps and primiparous births. The distribution of each was strikingly similar. 3. Sternomastoid tumours were right-sided in three-quarters of all cases and in an even higher proportion of the breech births. There was twice the expected incidence of plagiocephaly. Only one in seven proceeded to muscular torticollis, but in some of the remainder minor residua could be detected. 4. Muscular torticollis presented at any age, but one-third commenced in the first year of life. Only one in five gave a history of previous sternomastoid tumour. The contracture showed a predilection for the clavicular head, and was generally associated with some degree of facial asymmetry. 5. Nine of a combined 102 cases had a first or second degree similarly affected relative. 6. It is concluded that whatever the condition in the muscle at birth, it has three inconstant and variable sequelae. The torticollis may resolve completely; it may become clinically manifest as a tumour; or it may remain clinically latent, subsequently undergoing a variable degree of cicatrisation to produce torticollis. 7. The treatment of established torticollis by open division is described and the follow-up in thirty-six cases recorded. 8. This operation can be relied on to cure the principal deformity, but is accompanied by a number of minor cosmetic defects. Of these the most striking are tight bands apparently due to anomalous reattachment of the clavicular head, and loss of the sternomastoid column of the neck. 9. The method could not be relied on to cure facial asymmetry completely, even in the early years of life. However, there was some evidence to suggest that persistence of asymmetry was allied to persistence of other residua of the torticollis, for example fascial bands.

Konjenital Musküler Tortikollis: Tanı ve Tedavi Seçenekleri

“…KMT doğumda veya doğumdan 2 ay sonra fark edilir (15). Mac Donald sınıflamasına göre musküler tortikollis 3 gruba ayrılır: Birinci grup; SKM tümörü veya fibromatozis kolli olarak adlandırılır ve palpabl tümörün olduğu tortikollistir (2,4,16). En sık görülen musküler tortikollis tipidir.…”

Tortícolis muscular congénita: Hallazgos ultrasonográficos

“…Su evoluci6n clinica es generalmcnte benigna, con regresi6n de la masa turn oral cervical y de la inclinacidn de la cabeza 4 , pero puede dejar secuelas permanentes si no se trata medicamente 4 -5 . La ultrasonograffa tiene alto rendimiento en el estudio de las masas cervicales en el nino, especialmcnte su caracterizacion, determinaci6n de la cxtensi6n y relacion con organos vecinos 7 -8 .…”

“…Se manifiesta durante el periodo neonatal como una masa cervical en relacion al trayecto del musculo esternocleidomastoideo, que puede ser dolorosa y ser confundida clmicamente con otras masas, como ocurri6 en 14 de los 20 pacientes que se comentan. Puede presentarse tambien como acortamiento muscular con inclinacidn de la cabeza hacia el lado afectado y asociarse a cambios morfoldgicos faciales o craneanos, pudiendo alcanzar grados variables de hemiatrofia facial o deformacion plagiocefalica 4 . La ubicacion en el lado derecho del cuello se describe como la mas frecuente'' 4 , pero en nuestra serie fue ligeramenle mas comun en el izquierdo y solo ocasionalmente es bilateral 1 .…”

“…Puede presentarse tambien como acortamiento muscular con inclinacidn de la cabeza hacia el lado afectado y asociarse a cambios morfoldgicos faciales o craneanos, pudiendo alcanzar grados variables de hemiatrofia facial o deformacion plagiocefalica 4 . La ubicacion en el lado derecho del cuello se describe como la mas frecuente'' 4 , pero en nuestra serie fue ligeramenle mas comun en el izquierdo y solo ocasionalmente es bilateral 1 . Afecta con mucho mayor frecuencia los tercios superior y medio del musculo esternocleidomastoideo y preferentemente a varones 1 , como en los casos de esta serie (85%).…”

“…Sin embargo, a veces persisten alteraciones residuales por fibrosis y acortamiento del musculo esternocleidomastoideo afectado, que se manifiestan como engrosamiento muscular, asimetn'as posturales o morfologicas craneofaciales, las que pueden requerir cirugia 4 . Por este motive, se recomienda tratamiento medico con terapia ffsica o kinesilerapia precoces en lodos los casos, con lo que se obtiene regresion completa del trastorno, sin secuelas en por lo menos 90% de los afectados 2 .…”