Kittur Dinesh
Asst. Professor of Paediatric Surgery, Ankur Paed Surgical Clinic, Kolhapur, India; SJKC Trust's Paediatric Surgery Centre and Postgraduate Institute, Sangli, Maharashtra, India.
J Indian Assoc Pediatr Surg. 2016 Apr-Jun;21(2):57-60. doi: 10.4103/0971-9261.176936.
To study wheather the facial features return to normal after surgery for muscular torticollis done in early childhood.
This is a long-term study of the fate of facial asymmetry in four children who have undergone operation for muscular torticollis in early childhood. All the patients presented late, i.e., after the age of 4 years with a scarred sternomastoid and plagiocephaly, so conservative management with physiotherapy was not considered. All the patients had an x-ray of cervical spine and eye and dental checkup before making a diagnosis of muscular torticollis. Preoperative photograph of the patient's face was taken to counsel the parents about the secondary effect of short sternomastoid on facial features and the need for surgery. After division of sternomastoid muscle and release of cervical fascia when indicated, the head was maintained in a hyperextended position supported by sand bags for three days. Gradual physiotherapy was then started followed by wearing of a Minerva collar that the child wore for a maximum period of time in 24 h. Physiotherapy was continued three times a day till the range of movements of the head returned to normal. During the follow-up, serial photographs were taken to note the changes in the facial features.
In all four patients, the asymmetry of the face got corrected and the facial features returned to normal.
Most of the deformity of facial asymmetry gets corrected in the first two years after surgery. By adolescence, the face returns to normal.
研究幼儿期行肌性斜颈手术后面部特征是否恢复正常。
这是一项对4例幼儿期行肌性斜颈手术患儿面部不对称情况转归的长期研究。所有患儿就诊时均较晚，即4岁以后，伴有胸锁乳突肌瘢痕和斜头畸形，因此未考虑采用物理治疗的保守治疗方法。所有患儿在诊断为肌性斜颈之前均进行了颈椎X线检查以及眼科和牙科检查。拍摄患儿术前面部照片，以便向家长说明胸锁乳突肌短缩对面部特征的继发影响以及手术的必要性。在必要时切断胸锁乳突肌并松解颈部筋膜后，头部用沙袋支撑保持过伸位3天。然后开始逐步进行物理治疗，随后佩戴密涅瓦颈托，患儿在24小时内佩戴时间最长。物理治疗每天进行3次，直至头部活动范围恢复正常。在随访期间，拍摄系列照片以记录面部特征的变化。
所有4例患儿面部不对称均得到纠正，面部特征恢复正常。
大部分面部不对称畸形在术后头两年得到纠正。到青春期时，面部恢复正常。
