Congenital myotonic plagiocephaly is a relatively common congenital deformity of the neck in children, caused by shortening or fibrous contracture of the sternocleidomastoid muscle on one side. It is often detected within one month of birth. Early diagnosis and early treatment are effective. Otherwise, the deformity and secondary changes worsen with age, and the facial asymmetry and visualization are not at a level that is difficult to change. The real cause of this disease is unknown.
I. Clinical manifestations.
1. Within 1 month after birth, a pike shaped hard, painless mass is found in the middle of the sternocleidomastoid muscle on one side of the baby. It is more common on the right side and usually starts to shrink after 2 months and disappears after 4-6 months, turning into an inelastic fibrous band. The main manifestations are contracture of the affected sternocleidomastoid muscle and skewing of the head.
2. With the growth of age, developmental deformities of the head, face and neck (secondary deformities) appear. The head is tilted to the affected side, and the face and jaws are turned to the healthy side. The affected side is narrowed from top to bottom, flat and short, and the healthy side is round and long, with asymmetry on both sides. The distance between the external { and the corner of the mouth is not equal on both sides; the eyes and ears are not on a level; the cervicothoracic segment of the spine is laterally convex, and the concave side points to the affected side.
3. The head and neck rotate to the affected side and tilt to the healthy side with limited activity.
Second, the diagnosis is based on.
1. History of breech delivery or obstructed labor may be present.
2. Localized mass or pressure pain in the sternocleidomastoid muscle on one side, and later strip-like contracture.
3. Oblique neck deformity, head deviation to the affected side, face and jaw turning to the healthy side, facial asymmetry, lower eye and ear plane on the affected side, compensatory scoliosis of the head and cervical spine.
4.X-ray radiographs to exclude cervical spine developmental abnormalities, cervical tuberculosis, etc.
5.B ultrasound to clarify whether there is a significant difference between bilateral sternocleidomastoid muscles and whether the affected side of the sternocleidomastoid muscle has undergone impactological changes.
III. Treatment principles.
1.Early diagnosis and early treatment have good effect. Otherwise, the deformity and secondary changes aggravate with age, and it is difficult to change the facial asymmetry and visual not in one plane. Generally, it is better to treat before school age.
2.Manipulation treatment: It is suitable for those who are within 1 year old. If you can adhere to the manipulation treatment early, most of the correction can be obtained. Manual therapy mainly includes patient massage, head and neck rotation and stretching training and hot compress.
3.Surgical treatment: Applicable to children over 1 year old. Surgery is performed to cut off the contracted sternocleidomastoid muscle. In severe cases and older children, a brace can be worn in the overcorrected position for 3 months after surgery, and head rotation and stretching training can be performed at the same time.
Fourth, the principle of medication.
The disease cannot be treated with drugs.
V. Auxiliary examination.
The diagnosis of congenital myelomeningocele is not difficult based on the history and physical signs; X-ray is mainly used to exclude congenital malformation of the cervical spine and other acquired diseases; B-ultrasound clarifies the obvious difference of bilateral sternocleidomastoid muscles and the obvious hypertrophy and thickening of the affected side; strabismus should also be excluded.
VI. Evaluation of curative effect.
1.Cure: incision healing, rehabilitation training, mainly head turning and head and neck stretching training, until the neck movement is normal, regular review.
2.Treatment before puberty, the head and face asymmetry can be well shaped to reach a satisfactory appearance.