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Congenital Muscular Torticollis: Minimally Invasive Bipolar Tenotomy

February 19, 2016

Contributors: Federico Pilla, MD; Fabrizio Perna; Domenico Fenga, MD; Raffaele Borghi, MD; Matteo Nanni, MD; Francesco Traina, MD, PhD; Cesare Faldini, MD; Cesare Faldini, MD

2016 AWARD WINNER Congenital muscular torticollis (CMT) is a painless condition caused by unilateral shortening of the sternocleidomastoid muscle and usually presents during infancy. CMT occurs in 0.3% to 1.9% of all live births. The term torticollis is derived from the Latin words tortus, meaning twisted, and collum, meaning neck. In 1912, Tubby first defined CMT as "a deformity, congenital or acquired in origin, characterized by lateral inclination of the head toward the side of the affected muscle, with torsion of the neck and deviation of the face." CMT also was mentioned by Colonna in 1927 in describing Alexander the Great. The first documented division of the sternocleidomastoid muscle was performed by Isaac Minius in 1641. If diagnosed early, CMT can be managed nonsurgically, with some patients requiring surgery. In children older than 1 year, corrective surgery is associated with cosmetic and functional advantages. The goal of this video is to discuss the case presentation of a 7-year-old girl with CMT who was successfully treated via bipolar tenotomy of the sternocleidomastoid muscle and review postoperative management. The steps for bipolar tenotomy are presented and include preoperative imaging, surgical approach, and postoperative management (including the steps for packing a Minerva cast). At a follow-up of 12 months, the patient had complete head and neck range of motion with no head tilt or neck stiffness. Graphic illustrations are included in the video to explain the technique. Bipolar tenotomy is an easy and successful procedure with regard to cosmesis and function in patients in whom nonsurgical treatment fails and patients aged 1 year or older if it is performed in a stepwise manner.

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