title: Frontal cephalometric analysis in the evaluation of facial asymmetry in torticollis, and outcomes of bipolar release in patients over 6 years of age.
abstract: BACKGROUND
  The aim of this study was to investigate the mid-term results of bipolar release in congenital muscular torticollis patients over 6 years of age, and the efficacy of frontal cephalometric analysis in the determination and follow-up of facial asymmetry.
  
  
  METHODS
  Twelve patients (9 boys, 3 girls) from 7 to 12 years of age were included in the study. Bipolar release was performed, followed by 5-7 days of traction and 3 months of physiotherapy. Posteroanterior cephalometric radiography was performed at the beginning of and after therapy. The postural symmetry angle (PSA) was used to determine the presence and severity of facial asymmetry. A modified version of Lee et al.'s system was used in evaluating the results.
  
  
  RESULTS
  The average follow-up period was 3 years and 5 months. According to the congenital muscular torticollis evaluation system, the outcome was excellent in 2 of the patients, good in 6, fair in 2 and poor in 2. Asymmetry was not severe in all patients at the beginning of therapy according to PSA values, being insignificant in 2, mild in 6, and severe in 4. The PSA results of the last examination indicated that severe facial asymmetry persisted in 3 patients. In 2 of them, PSA values remained within the limits of severe asymmetry despite a slight angular correction.
  
  
  CONCLUSIONS
  Congenital muscular torticollis patients can benefit from surgical treatment over the age of 6 years. Bipolar release is an adequate and complication-free method. Moreover, PSA may be used as an objective method in the determination and follow-up of facial asymmetry in torticollis patients.
authors.affiliation: Department of Orthopedic and Trauma Surgery, The University of Dicle of School of Medicine, 21280-Diyarbakir, Turkey. diclehuseyin@hotmail.com
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Arslan
authors.forename: Seher
authors.initials: S
authors.lastname: Gündüz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Subaşi
authors.forename: Cumhur
authors.initials: C
authors.lastname: Kesemenli
authors.forename: Serdar
authors.initials: S
authors.lastname: Necmioğlu
authors.forename: Mehmet
authors.initials: M
authors.lastname: Subaşý
mesh_terms: D000293:Adolescent; D000328:Adult; D002508:Cephalometry; D002648:Child; D005146:Facial Asymmetry / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D014103:Torticollis / Q000150:complications* / Q000601:surgery*