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Congenital Muscula Torticollis

Congenital Muscula Torticollis. Dept of Pediatric Surg. Wang Daoxi. Appearance of a right sternomastoid tumor in infancy; the head is turned to the contralateral side. . TERMINOLOGY . N ewborn a sternomastoid lump. Older baby a fibrotic, shortened sternomastoid muscle,

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Congenital Muscula Torticollis

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  1. Congenital MusculaTorticollis Dept of Pediatric Surg. WangDaoxi

  2. Appearance of a right sternomastoid tumor in infancy; the head is turned to the contralateral side.

  3. TERMINOLOGY • Newborna sternomastoid lump. • Older baby a fibrotic, shortened sternomastoidmuscle, restriction of rotation of head

  4. ETIOLOGY • Many factors contribute to Torticollis • The high incidence of obstetric difficulties, such as breech presentation and the need for assisted delivery, may leadshortened sternomastoid muscle • Concomitant hip dysplasia is common .

  5. PATHOLOGY • Fibrous replacement of muscle bundles .

  6. CLINICAL FEATURES • The tumor is a hard, spindle-shaped, painless, discrete swell- ing usually about 1 to 3 cm in diameter within the substance of one sternomastoid muscle. Almost always, it first becomes ev- ident at about 3 weeks after birth. Obvious head tilt or torti- collis tends to develop later.

  7. Restriction of rotation of head

  8. Secondary Effects of Torticollis

  9. Plagiocephaly.

  10. DIAGNOSIS and DIFFERENTIAL DIAGNOSIS • squint • Posterior fossa tumors • Hemivertebrae • atlantoaxial rotatory subluxation

  11. Treatment • Conservative Management 1.Sternomastoid fibrosis resolves spontaneously in the vast majority of infants . 2.a)manipulation of the head and neck ; b) Physiotherapy and regular neck exercises ; c) intensive passive neck range-of-motion stretching exercises PS:No convincing evidence

  12. Treatment • Operative Treatment sternomastoidotomy • Indications for surgery include a)Persistentsternomastoidtightnesslimitingheadrotationin children more than 12 to 15 months of age b)Persistent sternomastoid tightness with progressive hemifacialhypoplasia c)Diagnosis in children older than 1 year

  13. The muscle is best divided at its lower end, although division at its upper end, at both ends,or in its midportion have all been described .

  14. COMPLICATIONS • Hematoma • Incomplete division may produce persistent torticollis. • Recurrent torticollis

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