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

Abstract

ObjectiveWe 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.MethodsThirty-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.ResultsThe 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.ConclusionBipolar release of the SCM is a safe and reliable technique for the treatment of CMT in adults.

Reversal of Degenerative Changes in Cervical Spine Following Bipolar Release in a Neglected Case of Congenital Muscular Torticollis: A Case Report

“…Best outcomes are obtained between 1 to 4 years of age group. After 5 years of age, the efficacy of surgery is reduced due to irreversible craniofacial deformity [7][8][9].…”

Outcome of surgical treatment for neglected congenital muscular torticollis: A series of 28 adolescent patients

“…The outcomes in this series were assessed using the cervicalmandibular angle (CMA) and an adapted version of the modified Lee’s criteria. [ 11 ] The CMA was calculated using radiological head tilt, defined as the angle between a line across the upper margin of the C7 vertebral body and another line that connects the inferior margins of the mandibular angles, as illustrated by Lee et al . [ 11 ]…”

“…[ 2 , 14 ] However, literature regarding neglected cases of CMT in adolescent patients is sparse. [ 11 , 17 , 18 ] Because most of these cases are successfully treated in infancy, CMT reports in older patients are scares, and therefore, the optimal surgical treatment is controversial. Surgical approaches include unipolar sternocleidomastoid release, bipolar sternocleidomastoid release with or without Z-plasty, selective denervation, and dorsal cord stimulation.…”

Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders

“…Side effects include cosmetic changes associated with permanent somatosensory loss or dysesthesia, scarring, or muscle atrophy. 43 An intrathecal baclofen pump might be another treatment option. Baclofen, an agonist of the gamma-aminobutyric acid type B receptor, blocks the release of this excitatory neurotransmitter by interfering with voltage-gated calcium channels.…”

“…In another study, Kim et al [ 42 ] reported significant improvement in radiological parameters such as the cervicomandibular angle and Cobb angle in 87 cervicothoracic scoliosis patients with congenital muscular torticollis. Side effects include cosmetic changes associated with permanent somatosensory loss or dysesthesia, scarring, or muscle atrophy [ 43 ].…”