1.What is baby’s squint?
Squinting, commonly known as “crooked neck”, is a fairly common surgical condition in small children. It usually occurs in young children and has four symptoms.
(1) Head tilted to one side, with the chin facing the opposite shoulder.
(2) The presence of a hard lump in the neck.
(3) Asymmetry in the size of the left and right side of the face.
(4) Restricted movement of the neck. These symptoms may be present at birth or may appear slowly at a later time, and some of them may disappear on their own without treatment.
2.Causes of squint neck?
There are many causes of a squint, such as abnormalities in the muscles, bones, and nerves that can cause the neck to tilt to one side. However, the most common cause of squint in children is fibrosis of the sternocleidomastoid muscle, which is the largest muscle in the neck.
”When the sternocleidomastoid muscle is located on both sides of the neck, the muscle on one side becomes stiff and short, causing the head to tilt to that side and the chin to tilt to the other side.
For example, in a left-sided sloping neck, the sternocleidomastoid muscle on the left side of the neck is fibrotic, and at this time, a hard muscle like bone can be felt on the left side of the neck, which will make the head tilt to the left side and the chin tilt to the right side.
This kind of muscle fibrosis occurs as early as the fetal period. Because a high percentage of mothers have a fetal malposition or even a breech birth, some parents misunderstand that the baby’s neck was twisted by the obstetrician and gynecologist during the birth.
In fact, it is unfair to blame the obstetrician and gynecologist, because according to the pathological examination, the fibrotic muscles are mature fibroblasts, and there is no injury or bleeding.
Other causes of oblique neck are also present, but are less common in young children, including
(1) Inflammation of neck tissues, such as acute lymph gland inflammation, which can also cause the head to tilt to one side because of swelling and pain.
(2) Sports injuries, poor sleeping posture, etc. may also cause muscle spasm on one side of the neck, causing asymmetrical neck movement.
(3) Visual asymmetry may also cause head tilting.
(4) Neurological diseases such as cerebral palsy may also have abnormal neck muscle contraction. The symptoms are similar to those of squints, but they are not the type of squints we are talking about in this article.
3.What is “sternocleidomastoid muscle”?
”The sternocleidomastoid muscle is the largest and thickest of the many muscles in the neck and is responsible for the movement of the head and neck in all directions. It is called the sternocleidomastoid muscle because it starts from the convex bone behind the ear (called the mastoid) to the sternum and clavicle in the front of the neck. If we turn our head to the side with force, we can see or feel that muscle. If we were to look to the right, the left sternocleidomastoid muscle would be stretched tight and become stiff. When we do not exert force, these muscles are soft.
4. Why do the neck muscles become fibrotic?
The body’s tissues become fibrous called “fibrosis”. Fibrotic tissue is usually used by the body to repair an injured area, for example, scarring is fibrous tissue. If normal tissue becomes fibrotic, something will go wrong because it loses its normal function.
Fibrous tissue is harder, so a hard lump will appear when the neck muscles are fibrotic. Although many people are studying it, the cause of fibrosis in the neck muscles is still unknown, and some people speculate that it may be caused by embolism of blood vessels or infection with a virus during muscle growth. Curiously, only the sternocleidomastoid muscle becomes fibrotic in squint, but not the other neck muscles.
5. How can I tell if my baby may have a squint?
The symptom of a squint is a lopsided head. When lying down, the baby tends to sleep on the same side; in a sitting position, the head is fixed to one side. Parents can try to attract the baby to look from side to side and find that the baby has difficulty in turning the head and neck.
Some children have a slanted neck in the womb, so their faces are not very symmetrical after birth. On closer examination after birth, there is often a hard lump in the neck (66%), about 1 to 3 centimeters in size, as if a tumor has grown on the neck! If left untreated, the lump may become a very tight band in older children.
6.How does the doctor diagnose the diastasis?
Usually the physician will observe the development of the head and face and palpate the neck with his or her hand. If there is an obvious hard lump or muscle fibrosis in the neck, the diagnosis is confirmed and there is usually no need to use other diagnostic tools.
Children who have symptoms of a squint but whose neck muscles are normal may need to have tests to look for other causes, such as x-rays and ultrasound.
7. Is it related to childbirth?
In many cases, the baby’s head is already tilted in the mother’s womb, making it difficult to deliver the baby. If the baby is born with a squint, the parents may misunderstand that the obstetrician hurt the baby during the delivery.
8.What are the effects of squinting neck disease?
The fibrotic muscles cannot contract and relax properly, and in addition to losing their function, they restrict the movement of the neck and make the muscles on both sides develop asymmetrically. In addition, because of sleeping on the same side all the time, the head and face will be pressed into left and right asymmetry. Because the skull of infants is still growing, the asymmetry still has a chance to recover before the age of 6 months, and it will be fixed after 6 months!
9.The best time for treatment?
The symmetry of the face and head is a very important indicator, the more asymmetry means the greater the impact of the squint, the more active and early treatment is needed. 6 months is the critical time for treatment, because after 6 months, the asymmetry of the head and face cannot be easily recovered, which can affect the appearance of the whole life.
10.Treatment method of squint neck?
Different treatment methods should be adopted for pediatric squint according to different causes.
(1) Congenital myelomeningocele. If a neck lump is found early in infants, it is difficult to predict whether the lump will dissipate on its own. Parents can be instructed to stretch the claviceps muscle with manipulation to tilt the neck to the opposite side (i.e. pushing). They can also go to the hospital rehabilitation department for physical therapy. Some scholars also advocate the injection of hormones into the local lump. In children, surgical release is suitable from 1 to 4 years old, but the effect of surgical release is poor above 5 years old and the facial asymmetry is not easily corrected.
(2) Cervical spine causes oblique neck. In addition to releasing the sternocleidomastoid muscle, cervical spine deformity orthopedic surgery should be performed.
(3) Subluxation between the first and second cervical vertebrae or fracture of the dentate process. Generally, only extension head traction is done to stabilize the vertebrae for 2-4 weeks, and most of the children can get a good recovery. If there is a combination of inflammation, antibacterial agents should be added. A small number of children with ineffective conservative treatment should consider surgical methods.
(4) Ophthalmic diseases, timely correction of strabismus.
(5) Habitual strabismus. After ruling out all the above causes, the unorthodox posture should be corrected, which can be corrected automatically after a long time.
11.Family correction method of infant squint.
(1) Use toys to attract infants to turn their heads to the direction opposite to the deformity.
(2) Sleeping, feeding, using the position opposite to the deformity.
(3) Apply hot towels or hot water bags to the area of the squinted neck for 30 minutes a day.
(4) Give the infant 5 times a day to do neck activities in the opposite direction of the deformity, maintaining 2 seconds each time and repeating 10 to 20 times.
(5) Knead the local lump. Let the infant lie on its side with the affected side on top and the back facing the surgeon, the surgeon pinches the local mass with the thumb, middle finger and index finger, and kneads it repeatedly 20 to 30 times from top to bottom and then from bottom to top in the direction of the sternocleidomastoid muscle, and gradually increase the finger force, and knead it for about 10 minutes, the mass will become soft when the technique and finger force are appropriate, then pinch the mass and pivot it to the left and right in the vertical direction, once a day for about 20 minutes. It is more effective to treat squinting neck within 1 year of age.
In addition, neck muscles that do not respond to physical therapy after a period of time and have significant sclerosis after 1 year of age should also be operated on. The surgery usually involves cutting away the sclerotic muscle so that it no longer interferes with movement. Most of the neck can resume normal movement after surgery, and the earlier the surgery, the better the results. If the surgery is performed too late, in addition to the deformation of the head and face, there will be some rehabilitation after the surgery to have better results. The chance of recurrence after surgery is less than 5?
12.Is the surgery dangerous?
The surgery itself is quite simple, only the fibrotic muscle is cut or partially removed, and the small patient only needs to stay one night and can be discharged the next day. Basically, heart patients under one year old can recover very quickly after the surgery. They can turn their heads around immediately and no longer need special treatment.
If treatment is delayed until very late, the head will still be habitually skewed after surgery, and physical therapy and four to five months of cervical correction will be needed before the head is fixed in the correct position: however, the deformation of the head and cheeks sometimes does not return to normal, so parents should not neglect it, so as not to treat it too slowly and regret it for the rest of their lives.
It is usually not difficult to diagnose and treat. The most important thing is to understand the impact of the disorder on the development of the head and face, and the treatment method and timing are related to the development of the head and face. Treating the condition too late or in the wrong way can have irreversible effects.