The effectiveness of a novel surgical approach for the treatment of congenital muscular torticollis

The outcomes of surgical treatment for congenital muscular torticollis (CMT) are poor in many cases, primarily from surgeon's fear of damage to important blood vessels in the carotid sheath. The current research aimed to establish a novel, safer and more effective surgical approach for the treatment of CMT based on the anatomic relationship between the fascial sheath of the sternocleidomastoid muscle and the carotid sheath. A total of 12 formalin-fixed cadaveric specimens (including 9 males and 3 females with average age of 48.1 years at the time of death) were used to observe the anatomical integrity and the compactness of the sternocleidomastoid fascial sheath and its relationship with the carotid sheath. From January 2013 to December 2015, 22 patients with CMT were treated surgically, including 12 males and 10 females with an average age of 13 years (range: 6-28 years). All patients underwent surgical treatment using the novel approach designed by the author, that is, separation of the fascial sheath of the sternocleidomastoid and the carotid sheath was performed. The fascial sheath of the sternocleidomastoid muscle is easily isolated from the carotid sheath in all specimens. All procedures were successfully completed. The space between the fascial sheath of the sternocleidomastoid muscle and the carotid sheath can be accessed in all patients. Carotid sheath contracture was identified in 1 patient and divided successfully. The average follow-up period was 19 months (range: 5 to 43 months). No postoperative lateral band was noted in the neck in any of the patients. Satisfaction regarding cosmetic and functional outcomes was considered excellent in 13 patients, good in 7 patients, and fair in 2 patients. The fascial sheath of the sternocleidomastoid muscle is easily isolated from the carotid sheath. This anatomical feature is the basis of division of the sternocleidomastoid muscle and can improve the safety and effectiveness of surgical treatment for CMT in patients older than 6 years old.