J Korean Neurosurg Soc.  2017 Jan;60(1):82-88. 10.3340/jkns.2016.0303.018.

Adult Patients with Congenital Muscular Torticollis Treated with Bipolar Release: Report of 31 Cases

• Lee GS
• Lee MK
• Kim WJ
• Kim HS
• Kim JH
• Kim YS

• KMID: 2365591
• DOI: http://doi.org/10.3340/jkns.2016.0303.018

Abstract

OBJECTIVE
We assessed the surgical results of bipolar release in 31 adult patients with uncorrected congenital muscular torticollis (CMT) and more than 12 months of follow-up.
METHODS
Thirty-one patients underwent a bipolar release of the sternocleidomastoid muscle (SCM) and were retrospectively analyzed. The mean follow-up period was 14.9 months (range, 12-30). The mean age at time of surgery was 30.3 years (range, 20-54). Patients were evaluated with a modified Lee's scoring system, cervicomandibular angle (CMA) measurement, and a global satisfaction rating scale using patient self-reporting.
RESULTS
The modified Lee's scoring system indicated excellent results in 4 (12.9%) patients, good in 18 (58.1%), and fair in 9 (29.0%) at the last follow-up after surgery. The improvements in neck movement and head tilt were statistically significant (p<0.05). The preoperative mean CMA was 15.4° (range, 5.4-29.0), which was reduced to a mean of CMA of 6.3° (range, 0-25) after surgery (p<0.05). The global satisfaction rating scale was 93.7% (range, 90-100). A transient sensory deficit on the ipsilateral lower ear lobe was noted in three cases. No significant permanent complications occurred.
CONCLUSION
Bipolar release of the SCM is a safe and reliable technique for the treatment of CMT in adults.

Keyword

Congenital; Torticollis; Adult; Sternocleidomastoid muscle; Tenotomy

MeSH Terms

Adult*
Ear
Follow-Up Studies
Head
Humans
Neck
Retrospective Studies
Tenotomy
Torticollis*

Figure

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  Fig. 1 Three popular operation for congenital muscular torticollis. A: Unipolar release. B: Bipolar release. C and D: Bipolar release with Z-plasty.

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  Fig. 2 A 42-year-old woman with uncorrected congenital muscular torticollis. Her head is tilted toward the right, with shoulder elevation and facial asymmetry. Preoperative photograph (A) and AP radiograph of the cervical spine (B). A postoperative photograph (C) and an AP radiograph of the cervical spine (D) of the same patient one year after bipolar release, showing improvement of head tilt and cervicomandibular angle.

• 

  Fig. 3 A 58-year-old woman with uncorrected congenital muscular torticollis. Preoperative photograph (A) and AP radiograph of the cervical spine (B). 24 months after surgery, postoperative photograph (C) and an AP radiograph of the cervical spine (D) showing marked improvement of head tilt and lateral shift of the head.

Reference

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