Primary Comparison Research For Plasty Of Muscular Torticollis By Traditional Surgery And Endoscopic Transaxillary Surgery Using Gasless Skin Lefting Method

BackgroundMuscular torticollis (MT) was first described by Tubby which is a common disease that can be easily seen in clinic. Literatures have reported that the incidence of MT was about 0.3% to 2% and the male to female ratio was about 3:2. The clinical manifestations of MT are head and neck tilting, function restricting, dissymmetrical for the reason of the affected side of the sternocleidomastoid muscle fibrous degeneration and contraction changes, what is more, it is also can cause the degeneration of the bones of vertebral column and pelvis. The triad including "Remarkable head tilt, Restricted neck rotation and palpable mass" was the common findings in physical examination. Most literatures recommended Non-surgical treatment for babies or infants with MT as the main treatment such as physical treatment and drug injection. If the patient failed to non-surgical treatment or the patient is older than 1 to 4 years, then operation is recommended for treatment. There are several kinds of traditional surgeries such as SCM unipolar release, SCM bipolar release and SCM "Z " plasty. During the operation, an incision about 3 to 4 cm would be made above the affected side clavicle about 1 cm. The traditional surgeries were effective to improve the rang of the motion of the neck, the degree of head tilt and so on. However, an notable scar will unavoidable with in the patient's neck after the operation. If the patient has scar diathesis, or special occupation such as an actor needs to expose his neck,the scar should be more shorter and well hided. With the progress of the society, to have a pretty neck is gradually become one of the pursuits of modern people for beauty and it is obviously that the traditional surgeries for MT could not meets that. To solve this problem, some scholars including Chinese and foreigners developed the endoscopic surgery for the plasty of MT. Burstein have reported their endoscopic surgery in 1998. They made an incision within the hairline in occiput through which they used scissors dissection to elevate the skin flap to establish the workspace and under the endoscopic vision they identified greater auricular nerve and cut the SCM. Sasaki reported that with the help of silk suture they used a CO2-insufflation to create the workspace and through a subcutaneously tunnel, under a direct and endoscopic vision they could identify and dissecte the sternal and clavicular attachments of SCM. Some internal experts such as Li Long, Xu Jian Guo have reported their endoscopic surgeries. They used a CO2-insufflation to create the workspace, made incisions in the middle and lower neck and axillary, used endoscopy, grasp, scissors to dissecte the sternal and clavicular attachments of SCM. These endoscopic surgeries have some shortages such as hypercapnia, instability workspace, small incisions in neck. To solve these problems we developed a new endoscopic surgery named endoscopic transaxillary surgery using gasless skin lefting method. In order to provide a safe, efficient and aesthetic surgery for clinic to rectify MT, we study the results of traditional surgeries and our new surgery in therapeutic efficacy and aesthetic efficacy. MethodsFrom Feb 2001 to Aug 2009 a total of 53 patients (loss 7) with MT were treated in our department. All the patients decided which surgery they would like to selected by themselves after introduction of the benefits and shortcomings of both surgeries.We divided the remaining 46 cases which were succeed follow-up into two groups as traditional group that 25 cases underwent traditional surgery and endoscopic group that 21 cases underwent endoscopic transaxillary surgery using gasless skin lefting method. We study the clinic data of both groups such as the average intra-operative blood loss, period of hospitalization, neck function recovery, post-operation recovery time, head and neck cosmetic feel and the satisfactory of the scar.Result1. Function of the neck of both groups were improved significantly.2.The average intra-operative blood loss, period of hospitalization, neck function recovery of the two groups have no significant deviation.3. The endoscopic group is much better than the traditional group in head and neck cosmetic feel and the satisfactory of the scar.ConclusionsEndoscopic transaxillary surgery using gasless skin lefting method is a safe, effective and esthetic method for the treatment of MT.