One Step Tenotomy in Congenital Torticollis: A Case Report

Azharuddin Azharuddin; Robby Sitohang

doi:10.3889/oamjms.2023.11079

Authors

Azharuddin Azharuddin Department of Orthopedics and Traumatology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
Robby Sitohang Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2023.11079

Keywords:

Congenital muscular torticollis, sternocleidomastoid release, tenotomy

Abstract

BACKGROUND: Congenital muscular torticollis (CMT) is a common pediatric abnormality involving sternocleidomastoid (SCM) muscle. The pathogenesis of CMT has yet to be elucidated, but intrauterine abnormalities seem to be a plausible explanation. This condition, if left untreated, may result in craniofacial asymmetry, neck pain, and limited neck movement. We reported a case of an 11-year-old girl with CMT, which symptoms were first noticed at the age of 4, but were neglected by her parents, the patient was then treated with a complete unipolar SCM release.

CASE PRESENTATION: An 11-year-old girl presented with neck stiffness and limited head movement, first noticed at the age of 4, but was neglected. These symptoms worsened within the last few weeks. Physical examination revealed tension and tightness in the left SCM muscle. The patient then underwent complete unipolar release of SCM muscle and proceeded to aggressive physiotherapy for 3 months and put to rigid collar neck for the next 3 weeks. Follow-up was done in the fourth week and a full range of motion (ROM) of the neck was achieved.

DISCUSSION: The timing of surgery could yield a good result if performed within 1–4 years of age. However, another literature stated that surgical intervention in the older patient with CMT could still result in better outcomes. Therefore, in this case, we proceeded to perform a complete unipolar release on the left SCM muscle. Post-operative results were satisfying, with significant improvement in neck ROM.

CONCLUSION: Surgical approach in adolescents with CMT may still carry a favorable outcome, in terms of better ROM and neck motion. Subsequent physiotherapy and brace placement were crucial to maintaining the results of the surgery.

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References

Ekici NY, Kizilay A, Akarcay M, Firat Y. Congenital muscular torticollis in older children: Treatment with Z-plasty technique. J Craniofac Surg. 2014;25(5):1867-9. https://doi.org/10.1097/SCS.0b013e31827c80cb PMid:25072975 DOI: https://doi.org/10.1097/SCS.0b013e31827c80cb

Kurniawan A, Canintika AF. A rare case of 9 years congenital muscular torticollis treated with complete unipolar sternocleidomastoid release: A case report and literature review. Int J Surg Case Rep. 2022;96:107298. https://doi.org/10.1016/j.ijscr.2022.107298 PMid:35738139 DOI: https://doi.org/10.1016/j.ijscr.2022.107298

Gundrathi J, Cunha B, Mendez MD. Congenital Torticollis. Treasure Island (FL): StatPearls Publishing; 2022.

Kim SM, Cha B, Jeong KS, Ha NH, Park MC. Clinical factors in patients with congenital muscular torticollis treated with surgical resection. Arch Plast Surg. 2019;46(5):414-20. https://doi.org/10.5999/aps.2019.00206 PMid:31550745 DOI: https://doi.org/10.5999/aps.2019.00206

Min KJ, Ahn AR, Park EJ, Yim SY. 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. https://doi.org/10.5535/arm.2016.40.1.34 PMid:26949667 DOI: https://doi.org/10.5535/arm.2016.40.1.34

Sargent B, Kaplan SL, Coulter C, Baker C. Congenital muscular torticollis: Bridging the gap between research and clinical practice. Paediatrics. 2019;144(2):e20190582. https://doi.org/10.1542/peds.2019-0582 PMid:31350358 DOI: https://doi.org/10.1542/peds.2019-0582

Nilesh K, Mukherji S. Congenital muscular torticollis. Ann Maxillofac Surg. 2013;3(2):198-200. https://doi.org/10.4103/2231-0746.119222 PMid:24205484 DOI: https://doi.org/10.4103/2231-0746.119222

Patwardhan S, Shyam AK, Sancheti P, Arora P, Nagda T, Naik P. Adult presentation of congenital muscular torticollis: A series of 12 patients treated with a bipolar release of sternocleidomastoid and Z-lengthening. J Bone Joint Surg Br. 2011;93(6):828-32. https://doi.org/10.1302/0301-620X.93B6.26232 PMid:21586785 DOI: https://doi.org/10.1302/0301-620X.93B6.26232

Chotigavanichaya C, Phongprapapan P, Wongcharoenwatana J, Eamsobhana P, Ariyawatkul T, Kaewpornsawan K. Prognostic factors in recurrent congenital muscular torticollis. Malays Orthop J. 2021;15(1):43-7. https://doi.org/10.5704/MOJ.2103.007 PMid:33880147 DOI: https://doi.org/10.5704/MOJ.2103.007

Dietzen A, Trovato M. Torticollis in Children and Adolescents. PM and R Knowledge Now. 2022. Available from: https://now.aapmr.org/torticollis [Last accessed on 2022 Sep 06].

Lee IJ, Lim SY, Song HS, Park MC. Complete tight fibrous band release and resection in congenital muscular torticollis. J Plast Reconstr Aesthet Surg. 2010;63(6):947-53. https://doi.org/10.1016/j.bjps.2009.05.017 PMid:19539550 DOI: https://doi.org/10.1016/j.bjps.2009.05.017

Matuszewski L, Pietrzyk D, Kandzierski G, Wilczynski M. Bilateral congenital torticollis: A case report with 25 years of follow-up. J Pediatr Orthop B. 2017;26(6):585-8. https://doi.org/10.1097/BPB.0000000000000407 PMid:27902637 DOI: https://doi.org/10.1097/BPB.0000000000000407

Ta JH, Krishnan M. Management of congenital muscular torticollis in a child: A case report and review. Int J Pediatr Otorhinolaryngol. 2012;76(11):1543-6. https://doi.org/10.1016/j.ijporl.2012.07.018 PMid:22889576 DOI: https://doi.org/10.1016/j.ijporl.2012.07.018

Cheng CY, Ho KW, Leung KK. Multi-adjustable post- operative orthosis for congenital muscular torticollis. Prosthet Orthot Int. 1993;17(2):115-9. https://doi.org/10.3109/03093649309164366 PMid:8233767 DOI: https://doi.org/10.3109/03093649309164366

Kuo AA, Tritasavit S, Graham JM Jr. Congenital muscular torticollis and positional plagiocephaly. Pediatr Rev. 2014;35(2):79-87; quiz 87. https://doi.org/10.1542/pir.35-2-79 PMid:24488831 DOI: https://doi.org/10.1542/pir.35.2.79

Keklicek H, Uygur F. A randomized controlled study on the efficiency of soft tissue mobilization in babies with congenital muscular torticollis. J Back Musculoskelet Rehabil. 2018;31(2):315-21. https://doi.org/10.3233/BMR-169746 PMid:28946532 DOI: https://doi.org/10.3233/BMR-169746

Ling CM. The influence of age on the results of open sternomastoid tenotomy in muscular torticollis. Clin Orthop Relat Res. 1976;116:142-8. PMid:1277634 DOI: https://doi.org/10.1097/00003086-197605000-00024

Kamboh UA, Ashraf M, Zahra SG, Raza MA, Manzoor M, Mehboob M, et al. Outcome of surgical treatment for neglected congenital muscular torticollis: A series of 28 adolescent patients. Surg Neurol Int. 2022;13:292. https://doi.org/10.25259/SNI_314_2022 PMid:35855133 DOI: https://doi.org/10.25259/SNI_314_2022

Seyhan N, Jasharllari L, Keskin M, Savacı N. Efficacy of bipolar release in neglected congenital muscular torticollis patients. Musculoskelet Surg. 2012;96(1):55-7. https://doi.org/10.1007/s12306-011-0170-3 PMid:22045346 DOI: https://doi.org/10.1007/s12306-011-0170-3

Hollier L, Kim J, Grayson BH, McCarthy JG. Congenital muscular torticollis and the associated craniofacial changes. Plast Reconstr Surg. 2000;105(3):827-35. https://doi.org/10.1097/00006534-200003000-00001 PMid:10724239 DOI: https://doi.org/10.1097/00006534-200003000-00001