Pediatric myotonic squint, commonly known as “crooked neck”, is a condition characterized by a child’s head tilted to the affected side and face rotated to the healthy side. Clinically, except for a very few cases caused by spinal deformity, visual impairment and neck muscle paralysis, myotonic squint is usually caused by contracture of the sternocleidomastoid muscle on one side.
This disease is mostly caused by the injury and bleeding of one side of the sternocleidomastoid muscle due to the extrusion of the birth canal or forceps during childbirth, and the contracture is formed by the mechanization of the hematoma; or the fetal head position is not correct during childbirth, which obstructs the blood flow and causes ischemic changes in the muscle, and the muscle fibers become edematous, degenerative and hyperplastic, and finally causes muscle contracture, resulting in myotonic squamous neck; or the fetal head is tilted to one side in the uterus, which obstructs the blood supply of one side of the sternocleidomastoid muscle and causes The ischemic change of this muscle is caused.
Clinical manifestations
1.After birth, a lump may appear on one side of the neck, oval or striated, mostly confined to the middle and lower part of the sternocleidomastoid muscle, and later the sternocleidomastoid muscle on the affected side becomes contracted and tense.
2, the child’s head is skewed to the affected side while the face is rotated to the healthy side, and the head and neck rotational activities are limited.
3, long duration of the disease, the affected side of the facial development is affected, significantly smaller than the healthy side.
4.Late stage may be accompanied by compensatory thoracic scoliosis.
5.In the early stage, there is no abnormal change in cervical spine X-ray examination, but in the late stage, cervical scoliosis deformity may appear.
Conservative treatment
1.Pressing and rubbing the affected sternocleidomastoid muscle and masses: with the child in lateral or supine position, the doctor sits on the healthy side and presses the affected sternocleidomastoid muscle and masses for 5 to 10 minutes. The action should be gentle.
2.Knead the sternocleidomastoid muscle on the affected side: repeatedly knead the sternocleidomastoid muscle from top to bottom for 3 to 5 minutes. The force should be light, and the force should be deep.
3.Passive exercise: with the passive movement of the neck, with the main focus on lateral bending to the healthy side and rotation of the affected side, repeatedly several times. The movement should be slow.
4.Wipe the sternocleidomastoid muscle on the affected side: apply pressure with the thumb and push and wipe the sternocleidomastoid muscle on the affected side from top to bottom 20 times.
Treatment: The earlier the treatment, the better the effect. Generally in children born within 3 months to start massage is better, massage once a day, the course of treatment is longer, it takes 3 ~ 6 months.
Precautions
1.When differentiated from bony squint, postural squint and neurological squint.
2. Timely detection and treatment. It is generally better to start treatment within 3 months of birth. When the lump disappears, pushing should be continued until the neck activity is normal.
3.For long duration of disease, if conservative treatment continues to be ineffective for more than six months, surgical correction can be considered.
4.Correct the head position, family members in daily life (such as breastfeeding, embrace, sleep pillow) to adopt the opposite direction of the oblique neck, in order to correct the oblique neck.
5, self-massage, family members can usually use the threaded surface of the index, middle and ring fingers in the affected side of the child’s neck with kneading method, rubbing the affected part of the child’s swollen nodes mainly.