congenital-torticollis2

Interventional neuropediatrics: treatment of dystonic and spastic muscular hyperactivity with botulinum toxin A.
Authors: Heinen F, Wissel J, Philipsen A, Mall V, Leititis JU, Schenkel A,
Stucker R, Korinthenberg R

Department of Neuropediatrics, University Hospital Freiburg, Germany.

Therapeutic effect of botulinum toxin A was studied in a group of
pediatric patients (n = 28) aged between 6 months and 18 years. The
patients were diagnosed with cervical dystonia (n = 6), adductor spasm
of the hip (n = 8), spastic drop foot (n = 7) and various other focal
motor problems associated with spastic muscular hyperactivity (n = 7).
The mean dose of botulinum toxin A (Dysport) used to inject into the
affected muscle was 22 U/kg body weight. Reduced muscular hyperactivity
with a significant increase in joint mobility was achieved for dystonic
(p < 0.0001) as well as for spastic conditions in patients with adductor
spasm (p < 0.0002). For these patients the improved joint mobility
represented a significant benefit for both daily activities and nursing
care. Local paresis and local hematoma were observed in 1/28 and 1/28
patients, respectively; 1/28 patients developed a secondary
non-response. However, apart from these side effects, no other adverse
reactions to botulinum toxin A treatment were recorded during the
Treatment and observation period (12-64 months). Our results suggest
that botulinum toxin A represents an effective and safe therapeutic
substance for the treatment of pediatric patients suffering of focal
motor problems due to dystonic or spastic muscular hyperactivity.

Endoscopic surgical treatment for congenital muscular torticollis.
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Abstract: Muscular torticollis, if untreated, may result in significant permanent craniofacial deformities. Surgical release of the sternocleidomastoid muscle is recommended for patients who fail to
respond to physical therapy. Current surgical techniques all leave noticeable scars, and provide limited exposure. These limitations make complete muscular release and visualization of the spinal accessory
nerve difficult. We have applied a new technique of endoscopic release of the sternocleidomastoid muscle in 12 infants and children ages 4 to 18 months and one adolescent with muscular torticollis. Complete
muscular release was achieved in all patients with one minor complication. The spinal accessory nerve was preserved in all cases. Our endoscopic approach allows precise division of the muscle fibers and
preservation of neurovascular structures, leaving an inconspicuous scar in the scalp.

Author:
�Burstein FD �Cohen SR
Address: Division of Plastic Surgery, Scottish Rite Children's Medical
Center, Atlanta, Ga, USA.

Late presentation of congenital muscular torticollis: a non-dystonic cause of torticollis.

Abstract: We describe three patients with a late presentation of
congenital muscular torticollis to emphasize that this non-dystonic type
of torticollis has to be considered in the differential diagnosis of
cervical dystonia, even in adult patients. Surgery is the treatment of
choice. Postoperatively, two of our patients had a transient lesion of
the accessory nerve. We assume that in our patients the accessory nerve
was embedded in the fibrous tissue around the affected muscle. To
prevent damage to the accessory nerve, the incision has to be made
distally at about 1 cm above the clavicle.

Author:
�Brans J �Aramideh M �Bosch A �Speelman H
Address: Department of Neurology, University of Amsterdam, The
Netherlands.

Torticollis in children caused by congenital anomalies of the atlas.

Dubousset-J
J-Bone-Joint-Surg-Am. 1986 Feb; 68(2): 178-88
Hemi-atlas is a rare congenital anomaly in the formation of the first
cervical vertebra. It may cause a rather severe and progressive
torticollis. When a child is young, the neck, despite the deformity, is
flexible and the torticollis can be passively corrected. However, in some
patients it becomes increasingly severe and fixed. I describe the findings
in seventeen patients, seven of whom were operated on between 1975 and
1983. Treatment with a brace was shown to be ineffective. In patients with
severe deformities, fusion of the upper part of the cervical spine is
recommended. Fusion was obtained in all seven patients in whom it was
attempted, and there was good postural correction in all. Early operation
is recommended if the deformity is increasing. Gradual correction in a
halo cast followed by posterior fusion is recommended as the treatment of
choice in patients with severe torticollis.

Biterminal tenotomy for the treatment of congenital muscular torticollis.
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Long-term results.
Wirth-C-J. Hagena-F-W. Wuelker-N. Siebert-W-E.
Orthopaedic Department, Hannover Medical School, Germany.
[1mJ-Bone-Joint-Surg- [m[Am]. 1992 [1mMar [m. 74(3). P 427-34.
     Fifty-five patients who, in a twenty-eight-year period, had been
     managed with a biterminal open release because of congenital
     muscular torticollis, were re-examined at an average of fifteen
     years and a minimum of five years after the operation. Forty-eight
     patients reported no functional or cosmetic impairment. Palpable
     soft-tissue strands remained in twenty-nine patients, but bending
     toward the untreated side was limited more than 10 degrees in only
     one patient. The rate of recurrence was 2 per cent. Facial
     asymmetry improved or resolved in more than one-half of the
     patients. We recommend that biterminal release be performed at the
     age of three to five years in all patients who do not respond to
     non-operative treatment. Author-abstract.