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Functional and Cosmetic Outcome of Unipolar Release of Congenital Muscular Torticollis in Children Above 1 Year
K C Saugat1, Yam P Gurung, Tarun Rajbhandary
1Hospital and Rehabilitation Centre for Disabled Children, Kavre, Banepa, Nepal.
Insights
Unipolar release surgery effectively treats congenital muscular torticollis (CMT) in children over one year old. This procedure significantly improves head tilt, range of motion, and facial symmetry, with favorable cosmetic results and minimal scarring.
Area of Science:
- Pediatric Orthopedics
- Musculoskeletal Disorders
- Surgical Outcomes
Background:
- Congenital muscular torticollis (CMT) is a common condition causing neck and facial deformities due to sternocleidomastoid muscle shortening.
- Untreated CMT can lead to permanent disfigurement.
- Unipolar release surgery offers a safe alternative, avoiding risks associated with the spinal accessory nerve.
Purpose of the Study:
- To evaluate the functional and cosmetic outcomes of distal unipolar release surgery for congenital muscular torticollis in children over one year of age.
- To assess improvements in range of motion, head tilt, and facial asymmetry post-surgery.
- To evaluate postoperative cosmetic results, including scar appearance and neck contour.
Main Methods:
- A retrospective study included 29 patients who underwent distal unipolar release surgery between 2016 and 2023.
- Preoperative and postoperative functional scores (range of motion, head tilt, facial asymmetry) were compared using the Lee and Kang scoring system.
- Postoperative cosmetic outcomes, including scar quality, loss of column, and lateral band, were assessed.
Main Results:
- Significant improvements were observed in lateral rotation limitation, head tilt, and facial asymmetry post-surgery.
- Preoperative limitations in range of motion improved from poor/fair to good/excellent in all patients.
- Postoperative cosmetic assessment showed excellent scars in 72% of cases, with no significant loss of neck column or lateral band abnormalities.
Conclusions:
- Distal unipolar release surgery demonstrates favorable functional and cosmetic outcomes for congenital muscular torticollis in children over one year old.
- The surgical intervention led to statistically significant improvements in all assessed preoperative functional parameters.
- The procedure is associated with positive cosmetic results, including satisfactory scar healing and neck appearance.
Background:
Congenital muscular torticollis (CMT) is a common congenital musculoskeletal anomaly where the affected sternocleidomastoid, surrounding soft tissues, and platysma progressively shorten causing ipsilateral head tilt and contralateral chin rotation. If untreated it may lead to permanent disfiguration of the neck and face. Unipolar release surgery is a convenient procedure without the risk of the spinal accessory nerve. Our study aims to report the functional and cosmetic outcomes of unipolar release surgery in children above 1 year.
Methods:
Twenty-nine patients who underwent distal unipolar release surgery from 2016 to 2023 were included. Preoperative functional scores: limitation of range of motion, head tilt, and facial asymmetry were compared with postoperative functional scores in the latest follow-up. Cosmetic score: scar, loss of column, and lateral band were postoperatively assessed in the latest follow-up. Lee and Kang scoring system was used.
Results:
The study participants had a mean age of 9.3±3.3 years with a mean follow-up of 3.5 years with 18 (63%) right-side and 11(38) left-side cases. Preoperative lateral rotation limitation was found to be poor in 11, fair in 15, and good in 3 cases, which progressed to good in 12 and excellent in 17 cases. The preoperative head tilt was found to be poor in 11, fair in 17, and good in 1 case, which after surgery was found to be good in 15 cases and excellent in 14 cases. Preoperative facial asymmetry cases were poor in 12 cases, fair in 16 cases, and good in 1 case, which postoperatively improved to 3 poor, 21 fair, and 5 good cases. Similarly, 21 (72%) cases had excellent scars and no loss of column.
Conclusion:
Unipolar release surgery has a favorable outcome in all our cases. All preoperative functional scores improved at our final follow-up and was statistically significant. Cosmetic outcome was also favorable.
