[Surgical treatment of congenital muscular torticollis--long term follow-up study of total resection procedure (Mikulicz) and histological examination of resected sternomastoid muscles (author's transl].
Total resection procedure (Mikulicz) was performed in 27 patients under 10 years of age with typical congenital muscular torticollis. Postoperative clinical assessment was carried out in 20 of these 27 patients. Resected sternomastoid muscles were studied histologically in 14 other patients. The operative procedures and histological findings were compared in a discussion of the relative values of conservative and operative treatment. Neck contracture due to torticollis improved immediately after operation and no recidivations followed. Skeletal deformity of the face and spinal column completely subsided within two or three years after the operation. Plagiocephaly remained and seemed not to be directly related to the torticollis. There were no patients with scar formation such as disfiguration or keratosis. Subcutaneous adhesion probably of the platysma with the deeper layer was palpable in three patients, but did not affect the clinical course. Accessory nerve injury during operation occurred in one patients, causing slight weakness of the trapezius muscle. On the other hand, disappearance of the sternomastoid muscle relief was cosmetically acceptable subjectively and objectively. The resected sternomastoid muscle in 14 patients with typical congenital muscular torticollis were studied histologically in specimens sectioned longitudinally. Hematoxylin-eosin, Masson's and van Gieson's stains were used and the distribution of the fibrosis throughout the muscles was examined. Fibrous changes were detected in almost the whole length and breadth. The changes were similar in all operated patients, although the ages were different. The findings by naked eye examination were usually less than those by histological examination. This follow-up study confirmed that total resection procedure gives good clinical results of congenital muscular torticollis. Histological studies suggested the need for removal of the fibrous changes involving the whole muscular tissue, as such changes can lead to recidivations.
D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D066298:In Vitro Techniques; D007223:Infant; D008297:Male; D008722:Methods; D009132:Muscles / Q000601:surgery*; D009334:Neck Muscles / Q000473:pathology / Q000601:surgery*; D014103:Torticollis / Q000151:congenital / Q000473:pathology / Q000601:surgery*