■先天性肌性斜颈是一种良性病变,定义为胸锁乳突肌挛缩或纤维化,导致同侧倾斜和对侧旋转的脸和下巴。管理是多学科的,通常是手术,应该在婴儿很早的时候开始,以确保更好的效果。因此,我们的研究目的是报告延迟手术对5岁以上晚期诊断的大龄儿童的结局.
方法:我们报告了4例年龄在5至11岁之间的先天性斜颈患者的病例。在2例臀位表现中,他们都是通过阴道分娩并进行真空抽提而出生的。即使这种情况在出生时就存在,大多数父母直到晚年才被孩子的颈椎恶性颈部位置所困扰,延迟诊断。临床检查在所有情况下都发现右侧头部弯曲位置,对侧旋转。关于年龄,我们建议立即对其中两人进行手术治疗,而两人在多次无效的物理治疗后被送往我们部门。手术包括右腱远端切开术,并在物理治疗旁边规定了子宫颈。他们都在纠正头部位置和改善颈椎范围运动方面取得了成功的结果。
■儿童早期接受积极且监测良好的康复治疗,完全恢复并迅速恢复正常的头部位置和活动能力。在年龄较大的孩子中,5年以上,他们更有可能发展出诸如面部运动不对称之类的续集。
结论:5岁后的延迟诊断仍然可以通过纠正头部位置和旋转运动来成功治疗。然而,在这些年龄较大的孩子中,单纯的物理治疗不能有效,应该与手术相关。此外,一旦诊断完成,应进行手术治疗,以避免浪费更多时间。
UNASSIGNED: Congenital muscular torticollis is a benign affection defined as a contracture or fibrosis of the sternocleidomastoid muscle, causing ipsilateral inclination and contralateral rotation of the face and chin. The management is multidisciplinary, usually surgical and should start at very early age in infants to secure better results. Thus, the purpose of our study is to report the outcomes of delayed surgery performed in older children above 5 years old with late diagnosis.
METHODS: We report the cases of 4 patients aged between 5 and 11 years old and followed in our department for congenital torticollis. They were all born by vaginal delivery with vacuum extraction in two cases of breech presentation. Even if the condition is present at birth, most parents were not bothered by the cervical vicious neck position of their children until a later age, delaying the diagnosis. The clinical examination found a flexed head position on the right side in all cases, with contralateral rotation. Regarding the age, we proposed surgical treatment immediately for two of them, while two were sent to our department after multiple ineffective physiotherapy sessions. The surgery consisted on right distal
tenotomy and a cervical collar was prescribed next to physiotherapy. They all had successful results with correction of head position and improvement of cervical range motion.
UNASSIGNED: Children treated early with active and well monitored rehabilitation, recover completely and regain normal head position and mobility rapidly. In older children, above 5 years, they are more likely to develop sequels such as asymmetry of facial movement.
CONCLUSIONS: Delayed diagnosis after the age of 5 years old still can be managed successfully with a correction of the head position and rotation motion. However, in these older children, physiotherapy alone cannot be effective and should be associated to surgery. Moreover, once the diagnosis is done, surgical treatment should be performed to avoid wasting more time.