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Bipolar sternocleidomastoid partial resection in pediatric patients case report: Technique and early outcomes
Kyle K Obana1, Annika Y Myers2, James T Bennett3
1Department of Orthopedic Surgery, Columbia University, New York, NY.
Rationale:
Congenital muscular torticollis (CMT) that is refractory to conservative therapy is often treated with unipolar or bipolar sternocleidomastoid (SCM) release. Prior texts and descriptions warn of overcorrection or defects, but these have not been encountered in our practice. However, recurrence and undercorrection have been observed, prompting us to transition to a bipolar release with partial resection of SCM. We will review the outcomes of this modified approach.
Patient Concerns:
Nine patients (6 males and 3 females) failed a trial of physical therapy and all conservative measures.
Diagnoses:
All patients were diagnosed with CMT refractory to conservative therapy.
Interventions:
Nine patients were treated with unipolar SCM (6 right and 3 left). The mean age at the time of surgery was 9.3±3.4 years.
Outcomes:
There were no surgical complications. No patients required subsequent revision surgery. One patient had prior surgery on the SCM.At final follow-up, 8 (88.9%) patients had a neutral head position. Rotation in the direction of the release significantly improved from preoperative to final follow-up (from 59.7±26.5 to 85.6±7.3 degrees, P = .01). Rotation in the opposite direction (away from the release) was maintained from preoperative to final follow-up (83.8±11.1 vs. 85.6±8.8 degrees, P = .71). No cases of overcorrection or defect in the area of the resection were observed.
Lessons:
Bipolar release with partial resection may be a promising form of treatment for CMT as head position was improved without overcorrection, defects, or other complications.
