Slanting neck (crooked neck)
Slanting neck is commonly known as crooked neck. Slanting neck can be divided into congenital muscular slanting neck and congenital bony slanting neck. The former is more common, and it is due to the crooked head and neck caused by contracture of the sternocleidomastoid muscle on one side.
1.Etiology
The etiology of congenital myotonic levator is still unknown. It is related to abnormal intrauterine pressure, fetal malposition, local blood circulation in the sternocleidomastoid muscle, obstructed labor, and genetic factors.
2.Clinical manifestations
(1) Oblique neck deformity
After birth, the infant’s head is tilted to the affected side, the face is rotated to the healthy side, and the lower jaw points to the healthy side of the shoulder. As the child grows and develops, the deformity becomes more and more serious.
(2) Neck mass
A cervical mass is usually palpable after birth or within 2 weeks after birth, without pressure pain, and is usually found on the right side.
(3) Facial deformity
If congenital myotonic neck is not treated effectively at an early stage, facial deformity will appear after 2 years of age. The main manifestation is facial asymmetry, the distance between the outer corner of the eyes and the corner of the mouth is asymmetric, including the nose and ears can also appear asymmetric changes.
3.Examination
(1) Ultrasound examination
Ultrasonography is very useful for congenital myotonic neck in children and can accurately differentiate it from other diseases of the neck, such as cystic lymphadenoma of the neck and enlarged lymph nodes in the neck.
(2) X-ray examination
It is useful to distinguish different causes of squint neck.
4.Differential diagnosis
It should be distinguished from congenital bony squint, pediatric cervical lymphadenitis, spontaneous atlantoaxial rotational subluxation, cervical tuberculosis and other diseases.
5.Treatment
(1) Non-surgical treatment
For children within half an age, non-surgical treatment can achieve satisfactory results. Therefore, once the diagnosis is made, treatment should be given as early as possible. The methods of non-surgical treatment include local hot compress, massage, bed immobilization and traction.
(2) Surgical treatment
(1) Surgical methods: depending on the severity of the disease, sternocleidomastoid excision, partial sternocleidomastoidectomy, total sternocleidomastoidectomy, sternocleidomastoid lengthening or sternocleidomastoid muscle upper and lower pole combined release.
(2) Postoperative treatment: children with severe oblique neck deformity and uncooperative children need to be corrected with head-neck-thorax cast or brace to maintain the position after surgery.