Application of cicatricial contracture release principles in muscular torticollis treatment

摘要

Background: Numerous surgical approaches for muscular torticollis are not effective enough to completely release the contracture and prevent further development of craniofacial asymmetry. Cosmetically unacceptable scars on the neck and compulsory functional exercises after surgery were also common problems. We applied the therapeutic principle of scar contracture to the surgical treatment of muscular torticollis. Surgical incision determination and the postoperative protocol were considerably improved. Satisfactory results were obtained. Method: According to the therapeutic principle of scar contracture, complete release of the contracted muscles and peripheral streak fascia and release or partial resection of peripheral normal tissues such as the scalenus anterior, anterior trapezius border, platysma, and partial carotid sheath are required to release all the affected contracted and tightened tissues. We chose to incise underneath the affected side of the clavicular border. We obtained a tension-free closure of the incision through an advanced skin flap of the inferior incision sutured on the clavicular fascia. Maximum head and neck stretch to the unaffected side of the shoulder when the patient lied down gave the affected side lateral decubitus position after surgery. Results: Satisfactory results were obtained and no complications were identified for all of the 104 patients. The development of craniofacial asymmetry and progressive deformities was prevented. The incision scar appeared linear in the pit above or below the clavicle border and was relatively inconspicuous. Conclusion: The application of the therapeutic principle of scar contracture to the surgical treatment of muscular torticollis was successful. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.