Publication:

Management of neglected cases of congenital muscular torticollis with bipolar release

Background Congenital muscular torticollis (CMT) is the third most common congenital musculoskeletal anomaly in children. After the age of one year functional and cosmetic benefits require corrective surgery. Neglected congenital torticollis is commoner in developing countries. The purpose of this study was to evaluate the results of bipolar release in this age group.

Methods 16 cases were operated on for neglected congenital muscular torticollis. Inclusion criteria included age of more than ten years, absence of any previous surgery, and absence of any known pathology. Inferior release was done through an incision 1 cm above the medial third of the clavicle. The clavicular head was released completely while the sternal head was lengthened by z-plasty. The mastoid head was released though an incision just below the tip of the mastoid process. The postoperative management included physiotherapy with halter traction. Neck ROM, head tilt, craniofacial asymmetry were assessed.

Results Excellent results were noted in four patients, good in eight, fair in two, and poor in two.

Conclusions We believe that bipolar release is a very viable option for correcting neglected CMT as it brought about both functional improvement as well as improvement in cosmesis, resulting in improved quality of life.