Department of Neurology, UCSF Medical Center, San Francisco, CA 94143, USA.
Parkinsonism Relat Disord. 2009 Sep;15(8):610-3. doi: 10.1016/j.parkreldis.2009.01.006. Epub 2009 Feb 27.
Anterocollis is a form of cervical dystonia characterized by forward neck flexion. While botulinum toxin is the treatment of choice for cervical dystonia, patients with anterocollis, who receive injections into the sternocleidomastoid and anterior scalene muscles, represent a disproportionate number of treatment failures. Deep cervical muscles such as the longus colli likely play an important role in neck flexion but are not routinely injected.
To describe a technique for longus colli injection in cases of anterocollis and to report the clinical outcomes of 10 such injections of botulinum toxin.
Three patients were referred for evaluation and treatment of anterocollis. All had previous treatment failures with sternocleidomastoid/anterior scalene injections or no activity noted on needle EMG investigation of these muscles. All patients received injections of botulinum toxin into the longus colli under fluoroscopic and EMG guidance.
All patients experienced symptomatic improvement (eight of 10 injections). Two patients reported mild dysphagia without serious complications after dose increases in botulinum toxin.
Incomplete muscle selection may be one cause of treatment failures in anterocollis. Deep cervical flexors such as the longus colli represent an under-recognized potential target for symptomatic treatment of anterocollis.
前屈颈是一种以颈部前屈为特征的颈部肌张力障碍。虽然肉毒毒素是治疗颈部肌张力障碍的首选方法，但接受胸锁乳突肌和前斜角肌注射的前屈颈患者代表了不成比例的治疗失败人数。像颈长肌这样的深层颈部肌肉可能在颈部弯曲中起着重要作用，但通常不进行注射。
描述一种用于前屈颈的颈长肌注射技术，并报告 10 例此类肉毒毒素注射的临床结果。
有 3 名患者因前屈颈而接受评估和治疗。所有患者均在前斜角肌/胸锁乳突肌注射失败或这些肌肉的针肌电图检查无活动的情况下接受治疗。所有患者均在透视和肌电图引导下接受颈长肌肉毒毒素注射。
所有患者均出现症状改善（10 次注射中有 8 次）。在增加肉毒毒素剂量后，有 2 名患者出现轻度吞咽困难，但无严重并发症。
肌肉选择不完整可能是前屈颈治疗失败的一个原因。深层颈部屈肌，如颈长肌，是治疗前屈颈症状的一个潜在被忽视的目标。
