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Surgical correction of muscular torticollis in older children
1Department of Orthopedics and Traumatology, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Insights
Surgical release for muscular torticollis in older children offers functional and cosmetic benefits. However, facial asymmetry may be irreversible if surgery is delayed past 12 years of age.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Craniofacial Surgery
Background:
- Muscular torticollis in children typically responds to conservative treatment if initiated before age one.
- Surgical intervention is reserved for persistent cases, with ongoing debate regarding optimal surgical techniques for older, neglected patients.
- Delayed surgical management in older children presents unique challenges and variable outcomes.
Purpose of the Study:
- To evaluate the efficacy of surgical correction for muscular torticollis in older children and young adults.
- To assess functional and cosmetic outcomes following surgical release in a cohort of patients aged over 12 years.
- To determine the impact of age at surgery on the long-term results of muscular torticollis correction.
Main Methods:
- A retrospective study of seventeen patients with muscular torticollis, mean age 9 years 5 months, who underwent surgical treatment.
- Surgical procedure involved a combined approach with open tenotomy at the mastoid and clavicular levels.
- Outcomes were assessed based on functional improvement and cosmetic appearance over an average follow-up of 3 years and 4 months.
Main Results:
- The study indicates that surgical correction yields better results in children younger than 12 years.
- Late surgical release in older patients provides acceptable functional and cosmetic outcomes.
- Facial asymmetry and residual upper dorsal scoliosis were observed in some older patients, highlighting the importance of timely intervention.
Conclusions:
- Surgical correction of muscular torticollis in older children is beneficial for both functional and cosmetic recovery.
- Facial asymmetry associated with muscular torticollis appears to be irreversible after the age of 12.
- Optimal surgical release combined with intensive postoperative physical therapy is crucial for achieving favorable outcomes in muscular torticollis management.
Background:
Children with muscular torticollis treated before the age of 1 year respond well to conservative treatment. Surgical correction is indicated only in resistant cases. Nevertheless, there is still controversy about the results and the type of operation in the management of neglected older children.
Methods:
Seventeen patients, at a mean age of 9 years and 5 months, with muscular torticollis were surgically treated between 1986 to 1991. The average follow-up period was 3 years and 4 months. months. Combined approach with open tenotomy at mastoid and clavicular level was the choice of procedure. The outcome for these older children and young adults were evaluated with function and cosmesis.
Results:
Our results showed that the best results can be expected in children before 12 years of age. Late releases give acceptable results, although facial asymmetry and some residual upper dorsal scoliosis remain. Adequate surgical release and intensive postoperative physical therapy are the keystones to a good result.
Conclusions:
Surgical correction of muscular torticollis in the older children is of benefit for functional and cosmetic recovery, but facial asymmetry is irreversible after 12 years of age.