Myotonic squint is also known as “congenital squint” and “sternocleidomastoid contracture squint”, commonly known as “crooked neck”. Congenital sternocleidomastoid is a common congenital deformity of the neck in children, which is 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 aggravate with age, and the facial asymmetry and visualization are not at a level that is difficult to change.
Etiology
The cause of congenital sternocleidomastoid is unclear. Modern medicine believes that this disease is mostly related to birth injury, fetal head malposition or the position of the fetal head in the uterus in a skewed state. The above-mentioned causes cause the sternocleidomastoid muscle to be compressed and the blood circulation to be obstructed, causing ischemic changes and finally leading to contracture of the sternocleidomastoid muscle and the appearance of oblique neck. There are mainly the hematoma theory, venous obstruction theory, arterial obstruction theory, genetic theory and hyperextension theory. In conclusion, the cause of congenital myotonic squamous neck is fibrosis and contracture of the affected sternocleidomastoid muscle. In addition to the above mentioned theories, there are also theories of intrauterine load, inflammation, fetal movement, etc. Among them, the theory of hematoma of birth injury has been rejected by most scholars, and it is believed that the pathogenesis of congenital myotonic levator is due to various factors, and the blood circulation disorder of the muscle is the direct cause of the pathogenesis, but congenital pathogenic factors cannot be excluded. The exact etiology and pathogenesis need to be further studied.
Clinical manifestations
1. Within one month after birth, a hard, painless mass in the middle of the sternocleidomastoid muscle is found on one side, mostly around 10 days after birth. 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. 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 of the face 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 at the same level; the cervicothoracic segment of the spine is lateralized, and the concave side points to the affected side.
3. Restricted rotation of the head and neck to the affected side and tilting activities to the healthy side.
Diagnosis
1. There may be a history of breech delivery or obstructed labor.
2. Localized mass or pressure pain in the sternocleidomastoid muscle on one side, and later a striated 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.
Treatment】
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 vision not in one plane. Generally, it is better to treat before school age.
2.Manipulation treatment: massage treatment for squint neck is applicable to those within 1 year old. Most of them can be corrected if they can adhere to the treatment early.
Commonly used techniques (for reference only, under the guidance of rehabilitation physicians)
(1) The child is in a supine position, with the head facing the parents, using talcum powder as the medium. The parent sits in front of the bed, holds the child’s neck and occipital area with one hand, and presses the sternocleidomastoid muscle on the affected side with the thumb of the other hand for 5 minutes.
(2) Hold and pinch the lump of the sternocleidomastoid muscle on the affected side, using the thumb, middle and index fingers to hold it carefully. Slightly increase the force, especially if the lump is pinched, but alternate with light kneading so that the child does not cry violently. The time is 2 minutes.
(3) Hold the affected shoulder with one hand and the top of the child’s head with the other hand, so that the child’s head is gradually tilted toward the healthy shoulder and the sternocleidomastoid muscle is elongated, and repeat the operation 5 times.
(4) Then relax the area by pressing and kneading for 5 minutes.
(5) Physical therapy such as local warmth or infrared light can be used to promote blood circulation and help absorption of the mass.
Life conditioning: parents should intentionally turn the child’s head to the healthy side to help correct the deformity when nursing, looking at things, carrying and sleeping.
3.Surgical treatment: cut off the contracted sternocleidomastoid muscle. After the surgery, a cervical brace or cephalothoracic cast can be fixed in the overcorrected position and removed after 4-6 weeks. Surgical treatment is suitable for children over 1 year old.
Follow-up】
1.Cure: The incision is healed, the oblique neck deformity is corrected, and the neck movement is normal.
2.Improvement: the oblique neck has improved, but the face is still asymmetrical.