title: Endoscopic transaxillary subfascial approach for persistent muscular torticollis in children.
abstract: BACKGROUND
  The endoscopic approach is a technical innovation for release of the sternocleidomastoid (SCM) fibrosis in muscular torticollis, where operation scars can be hidden at less conspicuous areas, for example, at the axilla and hair-bearing scalp. As the SCM muscle is located beneath the investing layer of deep cervical fascia which is reported to continue to the fascia of the pectoralis major, the aim of the study was to describe and evaluate the preliminary result of transaxillary subfascial approach for persistent muscular torticollis in children.
  
  
  METHODS
  A total of 4 children (2 boys and 2 girls) were included in this study from January to December 2009. Using a 2-port endoscopic technique, the division of the lower end of the fibrotic SCM muscle was performed through the subfascial working cavern. The subfascial dissection was performed under the fascia of the pectoralis major and above the muscular fibers from ipsilateral axilla with the aid of a homemade dissection balloon.
  
  
  RESULTS
  The mean operating time was 67.5±11.9 minutes (range: 55 to 80 min). There was no serious operative morbidity and the mean follow-up period was 14.8±5.1 months (range: 9 to 20 mo). All patients had complete unrestricted movement of the head and no recurrence was observed during this period.
  
  
  CONCLUSIONS
  The transaxillary endoscopic technique, a working cavern created under the fascia of the pectoralis major, offers a safe and straightforward way to surgically manage persistent muscular torticollis while preserving neurovascular structures, exempting extradissection of noninvolved tissues and avoiding the potential for poor cosmesis from any neck scar.
authors.affiliation: Department of Surgery, Kaohsiung Medical University Hospital, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 890300@ms.kmuh.org.tw
authors.forename: Yu-Tang
authors.initials: YT
authors.lastname: Chang
authors.forename: Jui-Ying
authors.initials: JY
authors.lastname: Lee
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Chiu
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Hsin
authors.forename: Chi-Shu
authors.initials: CS
authors.lastname: Chiu
mesh_terms: D002648:Child; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods*; D000071938:Fasciotomy; D005240:Feasibility Studies; D005260:Female; D005355:Fibrosis / Q000601:surgery; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery*; D010369:Pectoralis Muscles / Q000601:surgery*; D013997:Time Factors; D014103:Torticollis / Q000473:pathology / Q000601:surgery*