The Transaxillary Subcutaneous Endoscopic Sternocleidomastoid Muscle Division as an Approach for the Surgical Treatment of Congenital Muscular Torticollis in Children

  • Pradyumna PanEmail author
Original Article


Traditionally congenital muscular torticollis is treated with a neck incision which results in a neck scar. The purpose of this study was to evaluate the effectiveness of the transaxillary subcutaneous endoscopic sternocleidomastoid muscle division for the treatment of congenital muscular torticollis. This is a prospective study of 7 children with torticollis treated surgically by the transaxillary endoscopic approach in the department of Pediatric Surgery between 2014 and 2018. The age at operation ranged from 5.5 to 9 years, mean 7.3 (SD ± 1.3) years. The mean operation time was 65 min. The complete muscular release was successfully completed using the endoscopic approach. There were no major complications. All patients improved in gaze angle, lateral tilt and range of motion. There was no cosmetically unacceptable scar visible at the surgical sites in all patients during follow up. All families were pleased with the cosmetic outcome. The transaxillary subcutaneous endoscopic technique can be applied as a surgical approach for children with muscular torticollis an alternative to traditional open methods. It is a technically feasible procedure in children, provides excellent cosmesis and moreover avoids scarring on the neck.


Congenital muscular torticollis Surgical treatment Stealth surgery Subcutaneous endoscopic technique 



  1. 1.
    Cheng JC, Wong MW, Tang SP, Chen TM, Shum SL, Wong EM (2001) Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants. A prospective study of eight hundred and twenty-one cases. J Bone Joint Surg Am 83:679–687CrossRefGoogle Scholar
  2. 2.
    Bredenkamp JK, Hoover LA, Berke GS, Shaw A (1990) Congenital muscular torticollis. A spectrum of disease. Arch Otolaryngol Head Neck Surg 116(2):212–216CrossRefGoogle Scholar
  3. 3.
    Hollier L, Kim J, Grayson BH, McCarthy JG (2000) Congenital muscular torticollis and the associated craniofacial changes. Plast Reconstr Surg 105:827–835CrossRefGoogle Scholar
  4. 4.
    Bhaskar A, Harish U, Desai H (2017) Congenital muscular torticollis: use of gaze angle and translational deformity in assessment of facial asymmetry. Indian J Orthop 51(2):123–130CrossRefGoogle Scholar
  5. 5.
    Cheng JCY, Tang SP, Chen TMK (2000) The clinical presentation and outcome of treatment of congenital muscular torticollis in infants. A study of 1,086 cases. J Pediatr Surg 35:1091–1096CrossRefGoogle Scholar
  6. 6.
    Pricola KL, Dutta S (2010) Stealth surgery: subcutaneous endoscopic excision of benign lesions of the trunk and lower extremity. J Pediatric Surg 45:840–844CrossRefGoogle Scholar
  7. 7.
    Teja VS, Agarwal P, Bagdi RK (2017) Stealth surgery: subcutaneous endoscopic excision of benign lesions of head, neck and trunk in children. J Minim Access Surg 13(2):109–112PubMedPubMedCentralGoogle Scholar
  8. 8.
    Demirbilek S, Atayurt HF (1999) Congenital muscular torticollis and sternomastoid tumor: results of nonoperative treatment. J Pediatr Surg 34:549–551CrossRefGoogle Scholar
  9. 9.
    Seyhan N, Jasharllari L, Keskin M, Savacı N (2012) Efficacy of bipolar release in neglected congenital muscular torticollis patients. Musculo Skelet Surg 96:55–57CrossRefGoogle Scholar
  10. 10.
    Canale ST, Griffin DW, Hubbard CN (1982) Congenital muscular tortikollis: a long term follow up. J Bone Joint Surg Am 64:810–816CrossRefGoogle Scholar
  11. 11.
    Burnstein FD, Cohen SR (1998) Endoscopic surgical treatment for congenital muscular torticollis. Plast Reconstr Surg 101:20–24CrossRefGoogle Scholar
  12. 12.
    Dutta S, Albanese CT (2008) Transaxillary subcutaneous endoscopic release of the sternocleidomastoid muscle for treatment of persistent torticollis. J Pediatr Surg 43:447–450CrossRefGoogle Scholar
  13. 13.
    Tang S, Yang Y, Mao YZ (2010) Endoscopic transaxillary approach for congenital muscular torticollis. J Pediatr Surg 45:2191–2194CrossRefGoogle Scholar
  14. 14.
    Wang JL, Qi W, Liu Y (2018) Endoscopic release of congenital muscular torticollis with radiofrequency in teenagers. J Orthop Surg Res 3:1–6Google Scholar
  15. 15.
    Hsiao A, Pimpalwar A (2019) Subcutaneoscopic excision of external angular dermoid cysts: our covert scar approach in 11 cases. Eur J Pediatr Surg 29(03):239–242CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Pediatric Surgery UnitAshish Hospital and Research CentreJabalpurIndia

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