title: Is sternocleidomastoid muscle release effective in adults with neglected congenital muscular torticollis?
abstract: BACKGROUND
  Neglected congenital muscular torticollis is rare in adults but may be associated with pain and cosmetic problems. The efficacy of surgical correction in these patients has not been well established in the literature.
  
  
  OBJECTIVE
  We sought to describe (1) the primary goals that influenced adults with neglected muscular torticollis to seek surgical correction, (2) improvements of patients' function (specifically ROM) and radiographic parameters associated with deformities, (3) patient-derived outcomes using a previously published scale that includes function, and cosmesis, and (4) complications associated with sternocleidomastoid release in one surgeon's series of patients.
  
  
  METHODS
  We retrospectively reviewed the records of all adult patients who had surgical release of the sternocleidomastoid muscle between 2003 and 2011 by one surgeon and who were followed up for more than 1 year after surgery; 42 of these procedures were performed, and complete followup was available for 37 of them (88%). The mean age of the patients was 27 years (range, 18-48 years), and the minimum followup was 1.5 years (mean, 2.4 years; range, 1.5-4.7 years). The primary goal of the operation for each patient was determined to assess if it was met. Functional outcomes were assessed in terms of motion deficit: lateral flexion and rotation. Radiographic outcomes were assessed for cervicomandibular angle, lateral translation of the head and neck, and Cobb's angle of the cervicothoracic spine. The overall clinical results of surgery were assessed with the modified Cheng and Tang scoring system, and complications were tallied from a chart review.
  
  
  RESULTS
  The primary goals of surgery were cosmesis in 17 (46%) patients, pain in 11 (30%) patients, and function in nine (24%) patients. Patients for whom pain was the primary goal of surgery were older than the other patients. ROM and radiographic parameters associated with deformity consistently improved in these patients (p < 0.001 in all planes), and the overall results according to the modified Cheng and Tang scoring system indicated that 21 (57%) patients had an excellent result, 12 (32%) had a good result, and four (11%) had a fair result. There were no serious complications and no reoperations in these patients.
  
  
  CONCLUSIONS
  Sternocleidomastoid release was beneficial for the treatment of neglected congenital muscular torticollis in adults and was not associated with any serious complications. Surgical treatment led to cosmetic and functional improvements and relieved pain originating from the muscle imbalance brought about by the long-standing deformity.
  
  
  METHODS
  Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Kyung Sup
authors.initials: KS
authors.lastname: Lim
authors.forename: Jong Sup
authors.initials: JS
authors.lastname: Shim
authors.forename: Yeong Seok
authors.initials: YS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019547:Neck Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D019637:Orthopedic Procedures / Q000009:adverse effects; D010147:Pain Measurement; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D014103:Torticollis / Q000150:complications / Q000151:congenital* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult