title: Change of Facial Asymmetry in Patients With Congenital Muscular Torticollis After Surgical Release.
abstract: BACKGROUND
  A number of studies have shown that facial asymmetry improves in congenital muscular torticollis (CMT) patients after surgical release. This study confirmed the improvement in facial asymmetry, and analyzed factors that affect the change of facial asymmetry in CMT patients after surgical release by using objective and quantitative methods.
  
  
  METHODS
  Facial asymmetry was analyzed in 60 CMT patients who underwent surgical release before 10 years of age. Horizontal and lower facial asymmetry angles (HFAA and LFAA) in the clinical photograph were used to measure facial asymmetry. Postoperative improvements in HFAA and LFAA were evaluated in each age group, after grouping the patients by age. Patients were divided into 2 groups according to the postoperative head tilt and functional deficit. Postoperative improvements in HFAA and LFAA were compared between 2 groups. The relationships between postoperative improvements in HFAA and LFAA and independent variables (age, follow-up period, preoperative HFAA or LFAA, postoperative head tilt, and postoperative functional deficit) were analyzed.
  
  
  RESULTS
  Mean age at operation was 34.8 months (range, 6-120 mo). Horizontal facial asymmetry angle was improved significantly postoperatively in groups <5 years of age. Lower facial asymmetry angle was improved significantly postoperatively in all age groups. No significant difference was found in the postoperative improvements in HFAA and LFAA between 2 groups according to the postoperative head tilt and functional deficit. In the correlation analysis, postoperative improvements in HFAA and LFAA were proportional to the follow-up period (r = 0.256, P = 0.048) and preoperative HFAA or LFAA (r = 0.600, P < 0.001).
  
  
  CONCLUSIONS
  Facial asymmetry in CMT patients can be improved in part if surgical release is performed before 10 years of age and the possibility of improvement may be different according to the area of the face. After surgical release, facial asymmetry will improve over a long period of time, and patients with more severe facial asymmetry have a better remodeling potential to achieve facial symmetry.
authors.affiliation: *Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon †Pusan National University School of Medicine and Medical Research Institute, Busan ‡Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
authors.forename: Seung Jo
authors.initials: SJ
authors.lastname: Seo
authors.forename: Joo Hyoung
authors.initials: JH
authors.lastname: Kim
authors.forename: Young Hoo
authors.initials: YH
authors.lastname: Joh
authors.forename: Dong Ha
authors.initials: DH
authors.lastname: Park
authors.forename: Il Jae
authors.initials: IJ
authors.lastname: Lee
authors.forename: Hyoseob
authors.initials: H
authors.lastname: Lim
authors.forename: Myong Chul
authors.initials: MC
authors.lastname: Park
mesh_terms: D002648:Child; D002675:Child, Preschool; D005146:Facial Asymmetry / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009334:Neck Muscles / Q000503:physiopathology / Q000601:surgery; D018583:Pliability; D016059:Range of Motion, Articular / Q000502:physiology; D012399:Rotation; D014103:Torticollis / Q000151:congenital* / Q000601:surgery; D016896:Treatment Outcome