Congenital Muscular Torticollis Correction
Treatment of congenital muscular torticollis (spasticus) is indicated in cases of neck pain and for cosmetic reasons. Lengthening of the sternocleidomastoid muscle can be achieved by Z-plasty or suture or both muscle bellies. Accessory and greater auricul
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Philippe Bancel
Purpose The goal of the surgery is to treat the tilt of the head, to improve the cosmetic aspect of the face, to increase passive and active mobility, and to diminish pain.
of other pathogenetic causes of torticollis. An algorithm for the correct spastic torticollis syndrome diagnosis has been proposed including history (trauma, inflammation), palpation of the SCM, X-rays (anomalies), eye exam, neurologic evaluation, and pain [1].
Prerequisites
Patient Positioning
Surgery of congenital torticollis is indicated when a significant tilt of the head exists and when there is pain (in severe deformation); loss of passive and active mobility in lateral flexion and rotation (more than 15° of deficit), for cosmetic reasons; and presence of a tight fibrotic sternocleidomastoid muscle (SCM). Surgery is proposed only after failure of physical therapy program for more than 1 year.
Under general anesthesia and endotracheal intubation, the patient is placed in supine position and in slightly reversed Trendelenburg position. The head and the endotracheal tube are turned away from the pathologic side. The ear lobe is reversed and taped onto the temporomandibular joint, exposing the mastoid process (Fig. 29.5a, Case 2(a). A pillar is placed under the upper part of the thorax, and the shoulder is lowered using adhesive tape.
Planning and Diagnostics The theory of compartment syndrome by neck compression at the time of birth and delivery seems to be generally accepted. However, there is a long list—in children and young adults—
P. Bancel (*) Arago Intitute- Spine Department - Paris- Fance, Paris, France e-mail: [email protected]
Surgical Technique A vertical incision anterior to the SCM is performed, and then the subcutaneous tissue and platysma muscle are divided. The anterior border of the SCM is exposed from cranial to caudal, under the superficial layer of the cervical fascia. The cervical fascia is incised allowing the dissection of the SCM, particularly toward the posterior border.
© Springer Nature Switzerland AG 2019 H. Koller, Y. Robinson (eds.), Cervical Spine Surgery: Standard and Advanced Techniques, https://doi.org/10.1007/978-3-319-93432-7_29
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P. Bancel
190 Table 29.1 Pitfalls and complications Main complication and risks Facial nerve injury close to the cranial insertion of the SCM Accessory nerve (XI) injury below the deep mass of the muscle close to the mastoid process Internal jugular vein and carotid artery injury below the muscle with significant bleeding Greater auricular nerve injury close to the angle of the mandible
Preventive measures Careful dissection cranially Deep dissection of the SCM in this region can be avoided
Isolation of the two SCM bellies first after opening of the superficial cervical fascia. A flat retractor must then be placed between the muscle and the vessels Dissection can be avoided in this area
Pitfalls and complications of congenital torticollis correction: balance between correction and excess of lengthening
The two muscular origins ap
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