Congenital oblique neck is a deformity in which the neck is tilted to one side after birth, among which those caused by muscle lesions are called myogenic oblique neck; those caused by skeletal developmental deformities are called osteogenic oblique neck. The exact cause is unknown, and the combination of congenital hip dislocation or hip dysplasia reaches 7%-20%. The following is a brief discussion of congenital myelomeningocele.
I. Symptoms and signs
1. Neck mass
This is the earliest symptom discovered by the mother or midwife, usually can be touched after birth, located in the sternocleidomastoid muscle, shuttle-shaped, 2-4cm long, 1-2cm wide, hard texture, no pressure pain, the most obvious in the third week after birth, after 3 months that gradually disappeared, generally not more than six months.
2.Slanting neck
It can be found by the mother after birth, and the child’s head is tilted to the side of the mass (affected side). It becomes more obvious after half a month, and with the development of the child, the oblique neck deformity becomes more and more aggravated.
3. Facial asymmetry
Generally, after 2 years of age, the facial features are asymmetrical, mainly manifested as follows
(1) The affected side of the eye drops: due to the contracture of the sternocleidomastoid muscle, the position of the patient’s eye is shifted downward from the original horizontal shape, while the healthy side of the eye rises.
(2) Mandibular shift to the healthy side: The contraction of the sternocleidomastoid muscle also causes the affected mastoid to shift forward and the entire mandible (chin) to rotate and shift to the opposite side.
(3) Bilateral facial deformation: Due to the rotation of the head, the size of the bilateral facial holes are different, with the healthy side being plump and round, while the affected side is narrow and flat.
(4) Variation from the outer corner of the eye to the angle of the mouth: measurement of the distance from the outer corner of the eye to the ipsilateral angle of the mouth shows that the affected side is shorter and becomes more obvious with increasing age.
In addition to the above, the entire face of the child, including the nose and ears, gradually shows asymmetric changes and is basically fixed in adulthood, at which time the jaw and face will have a more unsightly appearance if surgical correction is performed. Therefore, the treatment should be carried out before school age, not later than 12 years old.
4.Other
(1) Concomitant deformity: check for hip dislocation, cervical vertebral deformity, etc.
(2) Visual impairment: both eyes are not at the same level due to the oblique neck, which can easily produce visual fatigue and affect visual acuity.
(3) Cervical scoliosis: mainly due to the head and neck rotating to the healthy side, thus causing compensatory scoliosis to the healthy side.
II. Treatment with medicine
1.Non-surgical treatment
(1) Indications: Mainly used for infants from birth to half a year old, and can also be used for light patients within 2 years of age as appropriate.
(2) Specific methods: Depending on the age of the child, the following methods can be used as appropriate.
(1) Massage: In newborns, once the disease is detected, massage should be applied to the mass immediately to improve the local blood supply and promote the softening and absorption of the mass. This is effective for mild cases and may even eliminate the need for later surgical correction.
(2) Hands-on traction: Starting about half a month after birth, the mother should use the time before breastfeeding to make the child lie flat on her lap and massage the affected area gently with one thumb, then use the other hand to rotate the baby’s head and neck to the affected side for a few seconds to achieve the purpose of traction on the contracted sternocleidomastoid muscle. This can be done 5 or 6 times a day for 0.5-1 min each time, and can be effective within 3-4 months in mild cases.
③Other: local hot compresses, rotating the baby’s head and neck to the affected side during sleep, and giving traction to the contracted sternocleidomastoid muscle. Since the child is just born, all kinds of operations need to be done carefully, meticulously and patiently, and do not cause any accidental injury due to excessive haste.
2.Surgical treatment
(1) Case selection.
(1) General surgical indications: children between the ages of half a week and 12 weeks are suitable.
(2) Relative surgical indications: children above 12 years of age, because their secondary facial deformities have already formed, the facial appearance may be more unsightly after correction of the squint, although it can be improved with human development, it is still not as effective as surgical treatment for the younger ones, and should be considered by parents at their discretion. According to the authors’ clinical experience, patients who undergo surgery before the age of 16 can achieve some improvement; patients around the age of 18 who opt for surgery can also be treated effectively. However, it is important to repeatedly explain to the family that the postoperative appearance is not good.
(3) Cases in which surgery is not appropriate: For cases of sloping neck due to other causes, such as vertebral malformation, tuberculosis, trauma, etc., the primary cause should be treated. For adults with oblique neck, unless there are other special reasons and requirements, the surgery should not be performed arbitrarily in general.
(2) Surgical method selection.
(1) Sternocleidomastoid excision: This is a traditional operation, and the muscle is usually excised at the sternal and clavicular end of the sternocleidomastoid muscle through a 1-1,5 cm long transverse incision. This procedure is simple, effective and easy to master. Some people also advocate cutting off the muscle from the mastoid end to maintain the aesthetic appearance of the neck, which is suitable for girls.
(2) Total sternocleidomastoid excision: The entire scarred sternocleidomastoid muscle is removed, which is a larger operation and is suitable for adolescent patients. Care should be taken not to accidentally injure the adjacent blood vessels and nerves during surgery.
Partial sternocleidomastoidectomy: It refers to the segmental excision of the sternocleidomastoid muscle that forms a mass, and is suitable for young children with obvious local masses.
(4) Sternocleidomastoid lengthening: applicable to those whose muscle tissue still has diastolic function.
(3) Postoperative treatment.
(1) For mild oblique neck deformity: the deformity can be corrected after surgery by rotating the head and neck to both sides, mainly to the affected side; however, this method is not applicable to uncooperative young children.
(2) Oblique neck deformity is obvious: after the operation, it is necessary to correct the deformity with head-neck-thorax cast and maintain the position of the child. Generally, it is fixed in a position that allows the sternocleidomastoid muscle to elongate, even though the head and neck are rotated to the affected side and tilted backwards. The cast is removed after 4-6 weeks of braking.
III. Dietary care
Eat a reasonable diet to ensure comprehensive and balanced nutrition. Diet should be light, eat more vegetables and fruits, quit smoking and alcohol, and eat less spicy and stimulating food.
Prognosis: The earlier the treatment, the better the results. In infancy, some patients can be cured if they insist on non-surgical treatment; in childhood or sternocleidomastoid contracture is not serious, surgery is needed and can be cured; sternocleidomastoid contracture is serious, facial asymmetry is obvious, and older patients can also have obvious effect, but cannot reach normal. the effect of treatment within 1 year old is obviously better than the efficacy after 1 year old.