Pediatric squint is a medical condition called congenital myotonic squint (commonly known as “crooked neck”), which is caused by a fibrous contracture of the sternocleidomastoid muscle on one side, resulting in a shortened and oblique deformity of the neck to one side, along with an affected facial development that is smaller than the opposite side. Most children can be completely cured with early and effective non-surgical treatment.
Causes
The cause is unknown and may be related to the following factors
1. The sternocleidomastoid muscle on one side is injured during childbirth, causing bleeding, forming a hematoma and then mechanizing, followed by contracture.
2, intrauterine fetal malposition, so that one side of the sternocleidomastoid muscle under excessive pressure, resulting in local ischemia, followed by excessive degeneration, replaced by fibrous connective tissue.
3.Aseptic inflammation caused by birth injury, resulting in muscle degeneration and scarring, and the formation of oblique neck.
4. Acute obstruction of the internal sternocleidomastoid vein at birth is related.
Pathogenesis
The pathogenesis is still unclear, mainly intrauterine compression theory: it is caused by the pressure change caused by the fetal malposition in the uterus. The theory of obstructed blood flow: occlusion of the arteriovenous branches supplying the sternocleidomastoid muscle causes fibrosis of the muscle. Genetic theory: About 1/5 of the affected children have a family history with other parts of the malformation. The theory of birth injury: Oblique neck is more frequent in cases of difficult delivery, especially in breech delivery, accounting for about 3/4. Jiao Lei, Department of Acupuncture and Massage (Department of Preventive Health Care), Weifang Hospital of Traditional Chinese Medicine
Clinical manifestations
One month after birth, the infant is found to have a pike shaped mass on one side of the sternocleidomastoid muscle, which is hard and inactive, gradually fading after 5 months, and the fibrous atrophy of the sternocleidomastoid muscle becomes short and striated. The pulling and pulling of the occipital area is biased towards the affected side of the jaw towards the healthy side of the shoulder, the healthy side of the face is full, and the affected side becomes smaller eyes are not at a correct level, which leads to cervical scoliosis deformity in severe cases.
Diagnosis and Differentiation
The diagnosis of congenital myotonic neck is not difficult, but it should be distinguished from other causes of myotonic neck. For example, bony squint, inflammation of the neck, and abnormalities of the eye muscles.
Auxiliary examination
Ultrasound examination can help identify myotonic squamous neck by comparing the thickness and texture of the sternocleidomastoid muscle on both sides.
1, bony squint: cervical spine abnormalities such as atlantoaxial subluxation, hemivertebrae, etc. X-ray continued examination can confirm the diagnosis, and the sternocleidomastoid muscle is not contracted.
2, cervical inflammation: meet lymph node enlargement, with pressure pain and systemic arrangement symptoms, no contracture of sternocleidomastoid muscle.
3, eye muscle abnormalities: muscle strength of the extraocular muscles is unbalanced, strabismus to the neck oblique coordination of vision, it is recommended to ophthalmology consultation to exclude.
Disease treatment
Treatment principles
The earlier the disease is treated, the better the results. Conservative treatment during infancy is satisfactory for most cases, and after 1 year of age, surgery is used if non-surgical treatment is ineffective. It is generally believed that the facial deformity is difficult to return to normal after the age of 3 years.
Conservative treatment
Applicable people: Applicable to infants after birth and less than half a year old, conservative treatment should be actively used to promote early absorption of hematoma and prevent muscle fiber contracture.
1.Massage: Massage can be done in the hospital first, and after the patient’s parents master the main points of manipulation, massage at home by themselves, which is convenient and easy to adhere to. The method is to use the fingers of the contracted sternocleidomastoid muscle for gentle twisting and smoothing, while kneading, 15 minutes each time, 2 to 3 times a day, gentle movements. Mild contracture of the sternocleidomastoid muscle can gradually be stretched, head and neck posture back to normal.
2.Sandbag fixation: let the baby lie on his back, face to the affected side, occiput to the healthy side, fixed with sandbag (or rice bag), keep the head in the above position.
3.Local massage: Apply talcum powder and massage repeatedly with the thumb or index finger in the lump, which can activate blood, reduce swelling, disperse knots, relieve spasm, promote the absorption of the lump and achieve the treatment purpose.
4.Pulling: continuously pull the head to the healthy side, about 30-50 times a day, can be done in parts. When doing so, put the child flat on the bed, the parents hold his head with both hands and turn his jaw to the affected shoulder (i.e. at the neck mass), pause for about 1 minute after turning, so that the muscles are in a stretched and extended state, and be gentle to prevent violence.
5.Position therapy: Relatives or nannies should choose their own position in relation to breastfeeding and sleeping according to the location of different lesions. For example, if the child has a right-sided sloping neck, you should put the child on your left side during feeding and sleeping, and vice versa.
Cautions.
1.When differentiated from bony squint, postural squint, oculogenic and other 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.If it is ineffective after 1 year old, surgery can be considered for correction.
4, children with oblique neck, should also pay attention to check whether there are other congenital deformities, especially congenital hip dislocation (can go to the hospital to take bilateral hip x-ray to confirm the diagnosis).
5.Children should not be held straight too early to prevent the occurrence of postural squint.