Results of Bipolar Release in Previously Unipolar Release of Congenital Muscular Torticollis

Purpose: Unipolar release of congenital muscular torticollis (CMT) is common in developing countries like India, Little has been published regarding the management of such patients. The aim of our study was to evaluate the results of bipolar release in these patients. Methods: Over a period of 12 months, total seven patients older than ten years with previously unipolar release of sternal end of congenital muscular torticollis (CMT) were operated on with bipolar release of sternocleidomastoid muscle. Postoperative protocol included head halter traction for three weeks followed by intensive physical therapy. Results were evaluated using a modified version of the system of Lee et al and Tanabe?s assessment criteria for torticollis. Results: Clinical and functional results were assessed using modified Lee?s scoring system and Tanabe?s assessment criteria for torticollis. Results were satisfactory in all the cases except one cases. At an average follow-up of around 12 months (range 6?12 months), excellent results were noted in three patients, good in two, fair in one, and poor in one. Postoperative improvements in range of motion, head tilt, chin deviation and cosmesis were noted in all patients, and these improvements were statistically significant. No surgery-related complications or recurrences requiring surgery occurred in any of the patients. Conclusions:-This study concluded that patients with CMT presenting with previously unipolar release of sternal end definitely benefit from surgery of bipolar release and complication-free method for such patients. We believe that bipolar release is a very viable option for correcting congenital muscular torticollis. The procedure is much more effective than unipolar release or subcutaneous tenotomy and is relatively complication free and safe. Lengthening of sternal head by Z-plasty restores the V-shape of base of neck, which adds to the cosmetic especially in a female patient.