Congenital muscular torticollis (CMT) is common in neonates, with a frequency of 0.3% to 2%, and usually responds to passive stretching below the age of one year. This study evaluated the results of performing an inferior Z-plasty release of the sternocleidomastoid muscle in older children with CMT. Six children who presented late with CMT were followed up for one to six years. They had a mean age at presentation of 10 years (range, five to 14 years). A cervical ultrasound scan was performed. None had a palpable mass, but all had severe muscle fibrosis. All were taught passive stretching exercises to be repeated every three hours, but these were ineffective and all six required surgery. They had no other congenital anomalies. Indications for surgery were a persistent head tilt and difficulty with passive rotation. Under general anaesthetic, the head was turned away from the affected side and a horizontal incision 1-2cm above the medial third of the clavicle was performed. The platysma was divided and the sternocleidomastoid muscle was dissected. The clavicular head was released by electrocautery and the sternal head was lengthened using a z-plasty. The tendon ends were approximated with 3/0 absorbable monofilament sutures and the incision was closed in layers. The normal neck contour was preserved. Neck exercises were started five days postoperatively in all patients. Four patients were also immobilised with a soft cervical collar for five to eight hours per day for two to six weeks. All patients did stretching exercises for at least 10 minutes four to six times daily. The mean follow-up was 3.5 years (range, 1-6 years). Head tilt and operative scar was evaluated clinically and all patients demonstrated improvement. This paper contributes to the literature on congenital muscular torticollis, with an elegant technique.

Congenital muscular torticollis in older children: treatment with Z-plasty technique.
Ekici NY, Kizilay A, Akarcay M, Firat Y.
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Aina Greig

St Thomas' Hospital, London, UK

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