2. Treatment: Make an incision in the horizontal direction of the upper clavicle (1.5cm) to free and loosen the sternocleidomastoid muscle. During the operation, the adhesion and contracture of sternocleidomastoid muscle and the newly formed fibrous cord at the original wound were cut off, separated and released. After operation, lie on the corrective pillow, fix the head with the corrective belt, and cooperate with the functional exercise of the head.
3. Results: After three weeks of treatment, the head and neck were upright as usual, and there was no recurrence during follow-up.
4. Discussion: Congenital muscular torticollis is a common disease, and its incidence is reported to be 0.4%, 1.3%. There are many theories about the etiology of this disease, and recently some scholars think it is the sequelae caused by intrauterine or perinatal fascial compartment syndrome. Its basic pathological changes are edema, degeneration and necrosis of sternocleidomastoid muscle, and finally it is replaced by fibrous tissue. The diagnosis of this disease is easy, and it can be diagnosed according to the mass of sternocleidomastoid muscle or contracture of sternocleidomastoid muscle and head and neck deviation. It is generally believed that the early treatment of muscular torticollis can be carried out by massage, manual traction, physical therapy and other methods. 1 and 4-year-old children should be treated surgically. However, incomplete surgical treatment or improper operation may still lead to poor postoperative results or recurrence. The incidence of secondary operation for congenital muscular torticollis was 7.84%. The incidence of reoperation in this group was 65438 00.87%.
(1) Selection of surgical incision: 2 cases of the original incision of the lower clavicle and 3 cases of the original incision of the upper clavicle. After operation, the wound adhered to form a new fibrous cord, the head and neck were still pulled and could not stand upright, the head movement was limited, and the corresponding facial deformation could not be improved or completely returned to normal. The transverse incision of upper clavicle 1.5cm can avoid postoperative adhesion of sternocleidomastoid muscle.
Congenital muscular torticollis-correction
(2) Subcutaneous free range: The subcutaneous free range should be above platysma during operation. Generally, the upper edge is at least 3cm and the lower edge is 0.5cm. The platysma muscle should be separated and cut off to avoid the adhesion between sternocleidomastoid muscle and platysma muscle after operation.
(3) Excision range of sternocleidomastoid muscle: Only two heads (sternal head and clavicle) of sternocleidomastoid muscle are removed. Fibrosis includes sternocleidomastoid muscle not being free and cut off, fibrotic muscle is not suitable for retraction, and it is easy to adhere after operation, which is also a factor affecting the postoperative effect.
(4) Whether the platysma muscle is sutured: When the wound is sutured, the platysma muscle is not sutured, which will not enlarge the neck wound. If the platysma muscle is sutured, the wound is easy to adhere, which affects the correction of the head and neck.
(5) Postoperative head and neck correction can not be ignored: especially children, their postoperative self-control ability is poor, so corresponding anti-correction methods should be taken to achieve the therapeutic purpose. According to the treatment experience, the surgical method is the main aspect, and postoperative correction and rehabilitation are also very important. These methods are practical and simple, can adjust the angle of anti-correction at any time, and are flexible and convenient for treatment and management.