Congenital muscular torticollis (contractel muscle) ( WFC ) – a persistent shortening of the sternocleidomastoid muscle, due to its underdevelopment and injury in the perinatal period , accompanied by a tilt of the head and the restriction of mobility of the cervical spine , and in severe cases – the deformation of the skull, spine and shoulder girdle .
Among the congenital disorders of the musculoskeletal appliances IUD is 12.4 % , ranking third after the frequency of congenital dislocation of the hip and clubfoot .
Depending on the timing of the appearance of the clinical picture of congenital muscular torticollis to distinguish between two forms : early and late .
At an early form of IUD , which is only observed in 4.5 -14 % of patients , from birth or in the first few days of life can only be detected by palpation shortening of sternocleidomastoid muscle or the presence of infiltration between the middle and lower thirds, or total seal sternocleidomastoid muscle. Rarely, and only in very severe deformities , forced position of the head with the asymmetry of the face and skull . With late form that occurs in the great majority of patients , the clinical signs of deformation increasing gradually . In the late 2nd – early 3rd week of life in patients with moderate to middle- lower third of the muscle appears solid consistency seal, which progresses and reaches a maximum value to 4 – 6 weeks. Sizes can range from a thickening of the hazelnut to walnut . In some cases, the muscle becomes easily dislodged spindle.
The skin over the sealed part of the muscle is not changed, there are no signs of inflammation . In 11 – 20 % of patients with a decrease in muscle thickening occurs her fibroid degeneration . Muscle becomes less stretchy and elastic, stunted . The skin over the muscle tension is raised in the form of wings. With the advent of thickening become noticeable tilt of the head in the direction of modified muscle and turn the face in the opposite direction , limitation of movement of the head.
In bilateral shortening of the sternocleidomastoid muscle ( two-sided torticollis ), head tilted back, so close to the back of his head , and his face looks up or tilted forward, that person looks down. The range of motion of the head is sharply limited , the cervical spine is curved in the sagittal plane.
Develop and aggravated secondary deformation face, skull , spine, shoulder girdle . The severity of secondary deformations formed is directly dependent on the degree of shortening of the muscle and the patient’s age .
With a long-term torticollis develop severe asymmetry of the skull. Half of the cranial muscles modified flattened , its height is less than from the intact muscle, eye , eyebrow located lower than the unmodified side.
Attempts to preserve the upright collar bone deformation , lateral movement of the head in the direction of the shortened muscle. In severe cases, scoliosis in the cervical and upper- thoracic spine bulge in the direction of the muscle intact . Further compensatory arc formed in the lumbar spine.
In carrying out medical treatment or occurs spontaneously reverse the development of thickened muscle. Sealing reduced in size and in muscle takes 2-12 months a normal thickness and elasticity .
Surgical treatment in the presence of clinical signs of torticollis is shown on reaching the age of patients 1-2 years, when conservative treatments exhaust the possibilities. The optimum age for surgery – 5-7 years ( before the first ” push growth” until the marked asymmetry of the facial skeleton ) .
Now for the elimination of congenital muscular torticollis the most widely used open intersection heads altered by S.T.Zatsepinu muscles in the lower part , and the intersection at the point of attachment to the mastoid process and fasciotomy of the medial triangle neck. The prognosis of the operation correctly and adequate rehabilitation treatment is favorable.
By shortening the muscles bolem than 40 % compared to the healthy , good treatment results can be obtained with Bat plastic elongation of sterno – clavicular muscles .
The main objectives of postoperative overcorrection is to maintain its head and neck, preventing the development of scars , restore healthy muscle tone overstretched half of the neck , working out the correct position of the head stereotype .
Immobilization is carried out within a month of thoraco – cranial plaster cast . When applying the plaster cast must be ensured that the patient’s head was tilted to the opposite side of the wound , turned towards the cross muscles , cervical spine tilted back and his head tilted forward.
After removing the plaster cast recommend patients for 3-6 weeks wearing a soft bandage type collar trench . Once appointed massage for toning the muscles on the side of healthy muscle , exercise therapy .
To prevent the development of scars Conductive physiotherapy lechvenie : elektrofarez potassium iodide , hyaluronidase , ronidaza . Also shown are the mud and paraffin .
Clinical supervision is carried out for the sick until the end of growth