NEGLECTED CONGENITAL MUSCULAR TORTICOLLIS TREATED WITH BIPOLAR RELEASE: A CASE REPORT AND OVERVIEW
Jurnal Ilmiah Kesehatan Iqra
Introduction Torticollis a symptom of cervical spine abnormality. The most common form of congenital painless torticollis is congenital muscular torticollis (CMT), or wry neck. This is a case of neglected congenital muscular torticollis treated by bipolar sternocleidomastoid (SCM) muscle release at the age of 12 years followed by active physiotherapy and exercises. Case report A 12-year-old girl affected with neglected congenital muscular torticollis involving the left SCM with no evidence of cervical vertebra abnormalities besides the increased cervicomandibular angle. A treatment plan of bipolar surgical release of the left SCM was formulated, followed by postoperative utilization of a cervical brace, aggressive physical therapy along with postural exercises. Functional and cosmetic result was excellent with improved cervical range of motion and centered head position. At 4 months postoperative, patient was able to extend the neck and perform rotation to the opposite site and there was only a moderate amount of scar tissue formed at the surgical site. Radiographic examination also revealed excellent postoperative CMA value. Discussion CMT has an unclear aetiology although it is postulated that foetal position abnormalities, intrauterine or perinatal compartment syndrome and birth trauma ensuing a difficulty delivery embody the main causes. The main approach to the condition remains a trial of conservative treatment consisting of stretching manoeuvres, although surgical release of the affected SCM is recommended for resistant cases. Manual stretching is most effective if performed before the age of 12 months. This stretching technique can also be combined with Botulinum toxin A injections. Surgery itself is highly recommended when a restriction of movement up to thirty degrees is present, as well in cases complicated with deformities of facial bones. Conclusion No clear consensus regarding which surgical technique provides the best chance at restoring a near normal function and cosmesis for neglected cases of CMT.
Antonios G Angoules, Eleni C Boutsikari, Eleni Latanioti. Congenital Muscular Torticollis: An Overview. J Gen Pract 2013, 1:1.
Chang, S.H., et al. A Surgical Treatment for Adult Muscular Torticollis. Case Reports in Orthopedics 2013.
Cheng, J.C.Y, Tang, S.P., Chen, T.M.K., Wong, M.W.N., Wong, E.M.C. The Clinical Presentation and Outcome of Treatment of Congenital Muscular Torticollis in Infants – A Study of 1086 Cases. J Pediatr Surg 2000; 35: 1091-1096.
Do T.T., Congenital muscular torticollis: Current concepts and review of treatment. Curr Opin Pediatr 2006; 18(1): 26-9.
Farzad Omidi-Kashani, Ebrahim G Hasankhani, Reza Sarifi, Mahdi Mazlumi. Is surgery recommended in adults with neglected congenital muscular torticollis? A prospective study. BMC Musculoskeletal Disorders 2008, 9 (158): 1-6.
Herring, J.A. 2014. Tachdjian’s Pediatric Orthopaedics 5th Edition. Philadelphia: Elsevier Saunde
Jaiswal, L.C.S., et al. Congenital Muscular Torticollis. MJAFI 2005; 61(3): 277-278.
Kyung-Jay Min, Ah-Reum Ahn, Eun-Ji Park, Shin-Young Yim. Effectiveness of Surgical Release in Patients with Neglected Congenital Muscular Torticollis According to Age at the Time of Surgery. Ann Rehabil Med 2016, 40(1):34-42.
Muralee Mohan, Smitha Bhat, Rajendra Prasad, S.M. Sharma, Tarun Lunawat Jain. Congenital Muscular Torticollis – Case Report and an Effective Treatment Plan. J. Maxillofac. Oral Surg. 11 (3): 364-367.
Patwardhan, S., et al. Adult presentation of congenital muscular torticollis. J Bone Joint Surg (Br) 2011; 93-8: 828-32.
Shashank R Ramdurg, Sharan B Kamareddy, Jayaprakash L reddy, Sidbassayya Gubbi. Neglected case of congenital muscular torticollis treated with Bipolar release: A Case Report. Sch J Med Case rep 2015; 3 (7): 639-641.
Ta, J.H., Krishnan, M., Management of congenital muscular torticollis in a child: A case report and review. Internation Journal of Pediatric Otorhinolaryngology 76 (2012): 1543-1546.