India-OrthAdult presentation of congenital muscular torticollis
A SERIES OF 12 PATIENTS TREATED WITH A BIPOLAR RELEASE OF STERNOCLEIDOMASTOID AND Z-LENGTHENING
This unique article is published in the June 2011 issue of the prestigious Journal JBJS Br.
The authors of this work were as follows:
S. Patwardhan, MS(Orth), Professor1; A. K. Shyam, MS(Orth), Assistant Professor and Chief Researcher1; P. Sancheti, MCh, MS(Orth), Professor1; P. Arora, Senior Registrar, MBBS, D. Orth, Orthopaedic Trainee1; T. Nagda, MS(Orth), Consultant Paediatric Orthopaedic Surgeon2; and P. Naik, MS(Orth), Associate Professor
Indian Orthopaedic Research Group was actively involved in this publication through 'MAPS' Programme
Abstract:
Adult presentation of neglected congenital muscular torticollis is rare. We report 12 patients with this condition who underwent a modified Ferkel’s release comprising a bipolar release of sternocleidomastoid with Z-lengthening. They had a mean age of 24 years (17 to 31) and were followed up for a minimum of two years. Post-operatively a cervical collar was applied for three weeks with intermittent supervised active assisted exercises for six weeks. Outcome was assessed using a modified Lee score and a Cheng and Tang score. The mean pre-operative rotational deficit was 8.25° (0° to 15°) and mean lateral flexion deficit was 20.42° (15° to 30°), which improved after treatment to a mean of 1.67° (0° to 5°) and 7.0° (4° to 14°) after treatment, respectively. According to the modified Lee scoring system, six patients had excellent results, two had good results and four had fair results, and using the Cheng and Tang score, eight patients had excellent results and four had good results.
Surgical management of adult patients with neglected congenital muscular torticollis using a modified Ferkel’s bipolarrelease gives excellent results. The range of neck movement and head tilt improved in all 12 patients and cosmesis improved in 11, despite the long-standing nature of the deformity.
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