Change of craniofacial deformity after sternocleidomastoid muscle release in pediatric patients with congenital muscular torticollis
Department of Orthopaedic Surgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea. The Journal of Bone and Joint Surgery
(Impact Factor: 5.28).
07/2012; 94(13):e93. DOI: 10.2106/JBJS.K.01567
Craniofacial deformity is one of the main features of congenital muscular torticollis. The purposes of this study were to quantify craniofacial deformity and its postsurgical change in patients with congenital muscular torticollis and to analyze this change with reference to the age at surgery.
Eighty patients with congenital muscular torticollis who had successful surgical release of the sternocleidomastoid muscle and had preoperative and follow-up cephalometric evaluation were studied. The craniofacial deformity was evaluated in two aspects: curvature and asymmetry. Postsurgical changes of craniofacial deformity were analyzed in all patients. Two groups of patients were identified: Group 1, which consisted of patients who had surgery before five years of age; and Group 2, which consisted of patients who had surgery at or after five years of age. Preoperative deformity parameters and the postsurgical changes were compared between Groups 1 and 2. Finally, postsurgical changes in the first and second year postoperatively were compared in forty-two patients for whom cephalometric radiographs were made at both the first and second-year follow-up visits.
All of the cephalometric parameters improved significantly after surgical release of the sternocleidomastoid muscle (p <0.001). The preoperative craniofacial asymmetry parameters, such as transverse calvarial asymmetry and transverse skull-base asymmetry, were significantly more severe in Group 1 than in Group 2 (p = 0.018 in both), and these parameters improved significantly more in Group 1 than in Group 2 postoperatively (p = 0.029 and 0.003, respectively). No significant difference between Groups 1 and 2 was found in postsurgical changes of craniofacial curvature and mastoid-process length ratio. The improvements were significantly larger in the first year than they were in the second year in all parameters except mastoid-process length ratio.
Cephalometry quantitatively showed improvement in the craniofacial deformity after surgical release of the sternocleidomastoid muscle. The results of this series were better when surgery was performed before the patient reached five years of age. More postsurgical change can be expected during the first year postoperatively than during the second year.
Available from: Sandra L Kaplan
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ABSTRACT: Congenital muscular torticollis (CMT) is an idiopathic postural deformity evident shortly after birth, typically characterized by lateral flexion of the head to one side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. CMT may be accompanied by other neurological or musculoskeletal conditions.
Infants with CMT are frequently referred to physical therapists (PTs) to treat their asymmetries. This evidence-based clinical practice guideline (CPG) provides guidance on which infants should be monitored, treated, and/or referred, and when and what PTs should treat. Based upon critical appraisal of literature and expert opinion, 16 action statements for screening, examination, intervention, and follow-up are linked with explicit levels of evidence. The CPG addresses referral, screening, examination and evaluation, prognosis, first-choice and supplemental interventions, consultation, discharge, follow-up, suggestions for implementation and compliance audits, flow sheets for referral paths and classification of CMT severity, and research recommendations.
Pediatric physical therapy: the official publication of the Section on Pediatrics of the American Physical Therapy Association 12/2013; 25(4):348-94. DOI:10.1097/PEP.0b013e3182a778d2 · 1.04 Impact Factor
Available from: PubMed Central
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ABSTRACT: To evaluate the craniofacial asymmetry in adults with neglected congenital muscular torticollis (CMT) by quantitative assessment based on craniofacial three-dimensional computed tomography (3D-CT).
Preoperative craniofacial asymmetry was measured by 3D-CT for 31 CMT subjects ≥18 years of age who visited a tertiary medical center and underwent 3D-CT between January 2009 and December 2013. The relationship between the age and the severity of craniofacial asymmetry was analyzed in reference to anteroposterior length asymmetry of the frontal bone and zygomatic arch, vertical and lateral displacements of the facial landmarks, and mandibular axis rotation.
The age at CT was 27.71±7.02 years (range, 18-44 years). All intra-class correlation coefficients were higher than 0.7, suggesting good inter-rater reliability (p<0.05) of all the measurements. The frontal and the zygomatic length ratio (i.e., the anteroposterior length asymmetry on the axial plane) was 1.06±0.03 and 1.07±0.03, respectively, which was increased significantly with age in the linear regression analysis (r(2)=0.176, p=0.019 and r(2)=0.188, p=0.015, respectively). The vertical or lateral displacement of the facial landmarks and rotation of the mandibular axis did not significantly correlate with age (p>0.05).
Craniofacial asymmetry of neglected CMT became more severe with age in terms of anteroposterior length asymmetry of the ipsilateral frontal bone and zygomatic arch on the axial plane even after growth cessation. This finding may enhance the understanding of therapeutic strategies for craniofacial asymmetry in adults with neglected CMT.
Annals of Rehabilitation Medicine 06/2015; 39(3):440-50. DOI:10.5535/arm.2015.39.3.440
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