Myotonic squint mostly develops from early childhood, often found a week or ten days or half a month after birth with a lump on the neck, which gradually hardens and then becomes a cord that pulls the head to the side. Usual treatment: local heat application, physiotherapy, massage and postural correction. Some patients can be cured. After 3-5 months of conservative treatment is not effective, to 1-2 years of age should be taken to surgical loosening treatment. Special attention should be drawn to the fact that if the child’s face starts to show the corresponding deformity, surgery should be performed decisively, even if the child is less than one year old. For children under half a year old, non-surgical treatment is the only way to achieve a satisfactory outcome. Once an infant’s oblique neck is detected, it should be treated as early as possible. Non-surgical treatment includes local heat, massage, bed immobilization and traction.
Massage
The patient is lying down with the head turned to the healthy side, the operator fixes the child’s head with one hand while the other finger is dipped in talcum powder or liquid paraffin. Once in the morning and once in the afternoon.
1, kneading: thumb or index finger belly on the mass, up and down, left and right, turn around (counterclockwise, clockwise direction) for light to moderate kneading, up and down constantly moving parts. Turn your head to the affected side and knead again. 5 — 6 minutes each time.
2, push: with the index finger on the affected side of the sternocleidomastoid muscle, from the mastoid to the end of the sternocleid, along the muscle walk from top to bottom, from bottom to top pushing each 30 times.
3. Press: Use the thumb to move up and down along the sternocleidomastoid muscle with one pressure and one release for 1 – 2 minutes.
For conservative treatment and postoperative rehabilitation.
1.The patient is lying down or sitting in a hug. The operator, with one hand holding the affected shoulder, presses and holds it in place. Hold the head with one hand, bend the head to the healthy side and hold it for half a minute, then recover and move it passively in turn, repeatedly for 30 times.
2.Patients lying down or sitting, the operator, one hand to support the affected shoulder, press and hold the fixed, one hand to support the head, the head to the affected side of the rotation to maintain half a minute, and then recover, in turn, passive activities.
3.Patients sitting or standing, the operator holds the head with both hands and slightly lifts the head upwards. Two to the affected side of the rotation, hold for 10 minutes, recovery, repeatedly do 10 times. Third, lateral flexion to the healthy side, hold for 10 minutes, recover, and do it 10 times repeatedly.
When the child is lying in bed, take the supine position, reverse the deformed position, fix the lower jaw to the affected side with a small sandbag, and turn the occiput to the healthy side position.
Indications and contraindications for surgery.
1.Applicable to those whose conservative treatment is ineffective over the age of half a week.
2, for those under 12 years of age who have obvious oblique neck deformity.
3.Surgical treatment can be considered if the facial deformity is not serious above 12 years old.
4.For adults, because the deformity has existed for many years, not only will the facial deformity be more obvious after surgery, but also the vision will be changed because it is not adapted to the new position after surgery, so surgery is not suitable.
There are several surgical methods as follows.
1, sternocleidomastoid muscle cut. It is one of the more commonly used surgical methods. A transverse incision is made on the clavicle to reveal the sternal and clavicular heads of the sternocleidomastoid muscle, which are cut above the attachment point, and the surrounding fascial tissue is loosened.
2.Sternocleidomastoid muscle partial excision. For those who have obvious neck mass, the mass of sternocleidomastoid muscle can be excised.
3.Postoperative treatment. Severe cases of oblique neck deformity and uncooperative children should be corrected with head-neck-thorax cast to maintain the position of the child.