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Congenital Muscular Torticollis: Minimally Invasive Bipolar Tenotomy

February 19, 2016

Contributors: Cesare Faldini, MD; Federico Pilla, MD; Fabrizio Perna; Domenico Fenga, MD; Raffaele Borghi, MD; Matteo Nanni, MD; Francesco Traina, MD

Congenital muscular torticollis (CMT) is a painless condition due to unilateral shortening of the sternocleidomastoid muscle (SCM) usually presenting during infancy. It shows up in 0.3-1.9% of all live births. The term torticollis is derived from the Latin words tortus, meaning "twisted" and collum, meaning "neck." Tubby in 1912 first defined it as "a deformity, congenital or acquired in origin, characterized by lateral inclination of the head toward the side of the affected muscle, with torsion of the neck and deviation of the face." The condition was also mentioned by Colonna in 1927 in describing Alexander The Great, and the first documented division of the SCM muscle was performed by Isaac Minius in 1641. When diagnosed early, CMT can be managed conservatively, sometimes requiring surgery. In children older than 1 year, corrective surgery has both cosmetic and functional benefits. The aim of this video is to show a case of CMT successfully managed by bipolar tenotomy of SCM and its postoperative management. Steps to perform a bipolar tenotomy, in a 7 years old girl presenting to our outpatient clinic with a non treated CMT, is presented including: preoperative imaging planning, surgical approach, and postoperative management (with the steps for packing a minerva cast). At 12 months follow up, the patient showed complete head and neck range of motion with no head tilt and neck stiffness. Graphic illustrations have been inserted to explain the technique. Bipolar tenotomy performed in cases resistent to conservative treatment or in patients aged one year or older is an easy and successful procedure both for cosmesis and function if it is performed stepwisely.

Results for "Pediatrics"