Dutta Sanjeev, Albanese Craig T
Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA 94305-5733, USA.
J Pediatr Surg. 2008 Mar;43(3):447-50. doi: 10.1016/j.jpedsurg.2007.10.008.
Surgical correction of torticollis is occasionally necessary to curtail the facial deformity that can result from this condition. The resultant neck scar can be of suboptimal cosmesis, with consequent psychological distress for the child. We have previously described an endoscopic approach to forehead and brow lesions through scalp incisions. We now describe a transaxillary subcutaneous endoscopic approach to division of the fibrotic sternocleidomastoid muscle.
This study involved a retrospective chart review of 3 consecutive outpatient procedures (male-to-female ratio, 1:2; age range, 8 months to 7 years) from March to October of 2005. The 2 older patients had established sternocleidomastoid fibrosis, and 1 had complicated torticollis refractory to medical management. All procedures were performed using standard 3-mm-laparoscopic instrumentation through hidden incisions in the ipsilateral axilla. Outcome measures included need for conversion, operative time, cosmetic outcome, and complications.
All patients were successfully treated endoscopically. Mean operative time was 50 minutes (range, 45-55 minutes). There were no intraoperative or postoperative complications. All families were pleased with the cosmetic outcome.
This case series demonstrates the simplicity and effectiveness of a transaxillary endoscopic subcutaneous approach to torticollis.
斜颈的手术矫正偶尔是必要的，以减少这种情况可能导致的面部畸形。由此产生的颈部瘢痕可能在美容效果上不尽人意，从而给患儿带来心理困扰。我们之前描述了一种通过头皮切口进行前额和眉部病变的内镜手术方法。现在我们描述一种经腋窝皮下内镜手术方法来切断纤维化的胸锁乳突肌。
本研究对2005年3月至10月连续进行的3例门诊手术（男女比例为1:2；年龄范围为8个月至7岁）进行了回顾性病历审查。2例年龄较大的患者已出现胸锁乳突肌纤维化，1例患有复杂的斜颈，药物治疗无效。所有手术均通过同侧腋窝的隐蔽切口，使用标准的3毫米腹腔镜器械进行。观察指标包括是否需要中转手术、手术时间、美容效果和并发症。
所有患者均通过内镜成功治疗。平均手术时间为50分钟（范围为45 - 55分钟）。无术中或术后并发症。所有家庭对美容效果都很满意。
本病例系列证明了经腋窝内镜皮下手术治疗斜颈的简便性和有效性。
