title: Results of bipolar release in the treatment of congenital muscular torticolis in patients older than 10 years of age.
abstract: OBJECTIVE
  Neglected congenital muscular torticollis (CMT) is a common presentation in developing countries like India, with the primary concern of the patients being cosmesis. Little has been published regarding the management of such patients. The aim of our study was to evaluate the results of bipolar release in this age group.
  
  
  METHODS
  Over a period of five years, 14 patients older than ten years (range 10-19 years) with neglected CMT were operated on with bipolar release of sternocleidomastoid muscle and z-plasty lengthening of the sternal end. Postoperative protocol included head halter traction for three weeks followed by intensive physical therapy. Results were evaluated using a modified version of the system of Lee et al.
  
  
  RESULTS
  At an average follow-up of around three years (range 1-5 years), excellent results were noted in three patients, good in seven, fair in two, and poor in two. Postoperative improvements in range of motion, head tilt, chin deviation and cosmesis were noted in all patients, and these improvements were statistically significant. No surgery-related complications or recurrences requiring surgery occurred in any of the patients.
  
  
  CONCLUSIONS
  This study concluded that patients with CMT presenting after ten years of age definitely benefit from surgery, and that bipolar release is an adequate and complication-free method for such patients.
authors.affiliation: Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160 012 India.
authors.forename: Pebam
authors.initials: P
authors.lastname: Sudesh
authors.forename: Kamal
authors.initials: K
authors.lastname: Bali
authors.forename: Aditya Krishna
authors.initials: AK
authors.lastname: Mootha
authors.forename: Mandeep Singh
authors.initials: MS
authors.lastname: Dhillon