O1057: What Are the Outcomes of Bipolar Sternocleidomastoid Partial Resection in Pediatric Patients?

Background: Congenital muscular torticollis (CMT) refractory to conservative therapy may be treated with unipolar or bipolar sternocleidomastoid (SCM) release. Some authors warn of overcorrection or muscle defects. Others warn of recurrence of deformity and under-correction. We hypothesize that bipolar release with partial resection of SCM at both sites will rarely result in over-correction, while under-correction or recurrence is more common.

Methods: CMT patients < 18 years of age treated with bipolar release with resection of 5-10mm of SCM were retrospectively identified from 1/1/04 to 2/14/19. Patients were excluded if range of motion was not documented or they had less than 6 weeks follow up.

Results: 9 patients (6 males, 3 females) met inclusion criteria. Mean age at the time of surgery was 9.3+3.4 years. Six (66.7%%) of the surgeries were on the right SCM and 3 (33.3%) were on the left. Mean duration of final follow-up was 189.6+140.4 days (range: 54 to 441 days).

At final follow-up, 8 (89%) patients had a neutral head position. Rotation in the direction of the release significantly improved from preoperative to final follow-up (from 59.7+26.5 to 85.6+7.3 degrees, p=0.01). Rotation in the opposite direction (away from the release) was maintained from preoperative to final follow-up (83.8+11.1 vs. 85.6+8.8 degrees, p=0.71). There were no surgical complications. No patients required subsequent revision surgery. No cases had overcorrection or defects in the area of the resection.

Conclusion: With bipolar SCM release and resection for refractory torticollis, 89% of patients achieved and maintained a neutral head position without any cases of overcorrection or defects. We recommend bipolar release and resection for treatment of CMT as head position was improved without overcorrection, defects or other complications.