Outcome of treatment for congenital muscular torticollis: a study on ages for treatment, treatment methods, and postoperative therapy

• Published in: European journal of orthopaedic surgery & traumatology 2009-07, Vol.19 (5), p.303-307
• Main Authors: Amemiya, Masahide, Kikkawa, Ichiro, Watanabe, Hideaki, Hoshino, Yuichi
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Original Article; Postoperative period; Surgery; Surgical Orthopedics; Traumatic Surgery
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-009-0424-z

The objective of this study is to review the clinical course after surgical treatment of congenital muscular torticollis and investigate the problems. Based on the treatment strategy of our institution for patients with congenital muscular torticollis, we treated young children with unipolar tenotomy of the sternocleidomastoid muscle, with postoperative use of our original brace, and school age or older children with bipolar tenotomy of the sternocleidomastoid muscle and postoperative use of a simple immobilizing brace, mainly a Philadelphia collar. This study included nine patients who underwent unipolar or bipolar tenotomy of the sternocleidomastoid muscle in our department between November 1990 and April 2006. Of these, four were boys and five were girls. Seven had right and two had left torticollis. The age at surgery ranged from 1 year 6 months to 24 years. Five underwent unipolar tenotomy and four underwent bipolar tenotomy. The study period from the first visit to the present ranged from 1 year 6 months to 18 years 9 months. The evaluation was based on the presence of recurrence and the assessment criteria described by Tanabe (Arch Orthop Trauma Surg 122:489–493, 2002). Three of five patients treated with unipolar tenotomy had a second surgery due to recurrence. None of those treated with bipolar tenotomy experienced recurrence. According to Tanabe’s criteria, among the five patients treated with unipolar tenotomy, two were graded as excellent, two fair, and one poor. And among the four treated with bipolar tenotomy, three were graded as excellent and one fair. Although this study included only nine patients treated and followed-up, more than half of those treated with unipolar tenotomy of the sternocleidomastoid muscle experienced recurrence requiring further surgery. Among those treated with bipolar tenotomy, the outcomes were generally good, and no recurrence was observed. Unipolar tenotomy of the sternocleidomastoid muscle in young children requires special attention with regard to recurrence. We decided to conduct bipolar tenotomy in young children and investigate future outcomes.