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Endoscopic transaxillary subfascial approach for persistent muscular torticollis in children
Yu-Tang Chang1, Jui-Ying Lee, Wen-Chun Chiu
1Department of Surgery, Kaohsiung Medical University Hospital, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 890300@ms.kmuh.org.tw
Insights
The transaxillary endoscopic approach offers a safe surgical solution for persistent muscular torticollis in children. This method effectively releases sternocleidomastoid (SCM) fibrosis with no recurrence and minimal scarring.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Techniques
- Craniofacial Surgery
Background:
- Muscular torticollis in children often involves sternocleidomastoid (SCM) muscle fibrosis.
- Traditional surgical scars can be cosmetically concerning.
- An endoscopic approach allows for scar concealment in less visible areas like the axilla.
Purpose of the Study:
- To describe and evaluate the preliminary outcomes of a transaxillary subfascial endoscopic approach for treating persistent muscular torticollis in pediatric patients.
- To assess the safety and efficacy of this minimally invasive technique.
Main Methods:
- A 2-port endoscopic technique was employed in 4 children (2 boys, 2 girls).
- The lower end of the fibrotic SCM muscle was divided through a subfascial working cavern created via the ipsilateral axilla.
- Dissection occurred under the pectoralis major fascia and above SCM muscle fibers, utilizing a homemade dissection balloon.
Main Results:
- The mean operative time was 67.5 minutes.
- No serious operative morbidity was reported.
- All patients achieved complete, unrestricted head movement with no recurrence during a mean follow-up of 14.8 months.
Conclusions:
- The transaxillary endoscopic technique provides a safe and effective surgical management for persistent muscular torticollis.
- This method preserves neurovascular structures, avoids unnecessary dissection, and prevents conspicuous neck scarring.
- It represents a straightforward approach for pediatric patients with this condition.
Background:
The endoscopic approach is a technical innovation for release of the sternocleidomastoid (SCM) fibrosis in muscular torticollis, where operation scars can be hidden at less conspicuous areas, for example, at the axilla and hair-bearing scalp. As the SCM muscle is located beneath the investing layer of deep cervical fascia which is reported to continue to the fascia of the pectoralis major, the aim of the study was to describe and evaluate the preliminary result of transaxillary subfascial approach for persistent muscular torticollis in children.
Methods:
A total of 4 children (2 boys and 2 girls) were included in this study from January to December 2009. Using a 2-port endoscopic technique, the division of the lower end of the fibrotic SCM muscle was performed through the subfascial working cavern. The subfascial dissection was performed under the fascia of the pectoralis major and above the muscular fibers from ipsilateral axilla with the aid of a homemade dissection balloon.
Results:
The mean operating time was 67.5±11.9 minutes (range: 55 to 80 min). There was no serious operative morbidity and the mean follow-up period was 14.8±5.1 months (range: 9 to 20 mo). All patients had complete unrestricted movement of the head and no recurrence was observed during this period.
Conclusions:
The transaxillary endoscopic technique, a working cavern created under the fascia of the pectoralis major, offers a safe and straightforward way to surgically manage persistent muscular torticollis while preserving neurovascular structures, exempting extradissection of noninvolved tissues and avoiding the potential for poor cosmesis from any neck scar.
