Congenital muscular torticollis: Use of gaze angle and translational deformity in assessment of facial asymmetry.
Congenital muscular torticollis: Use of gaze angle and translational deformity in assessment of facial asymmetry.
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DOI：
10.4103/ortho.ijortho_114_16
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发表时间：
2017-03
影响因子：
1
通讯作者：
Desai H
中科院分区：
文献类型：
--
作者：
Bhaskar A;Harish U;Desai H
斜颈畸形中面部不对称的评估具有挑战性。斜颈的颈部倾斜与水平视线偏离和颈部偏离中线有关。这些偏差可以在临床上进行评估，并可作为面部不对称的替代标志。将35例先天性肌性斜颈（CMT）患儿根据新的临床评分分为三个严重程度。评分系统的参数包括旋转缺陷、侧屈缺陷、凝视角度（GA）和平动畸形（TD）。7名儿童患有I级（轻度），18名患有II级（中度），10名患有III级（严重）CMT。其中女孩21例，男孩14例，平均年龄8.46岁（3 ~ 16岁）。22名儿童接受了双相释放，13名接受了单极手术。注意面部不对称（FA）迹象，并以GA和TD为基础；所有患儿均偏离中性角（胸骨正中铅垂线偏角90°和偏离中性角0 mm视为中性角）。最终结果以修改后的程、唐评分为基础。I级、II级和III级的平均GA分别从81.71提高到90、72.77提高到89.16、66.60提高到88 （χ 2 P < 0.0001）。I级、II级和III级的TD分别从15 mm提高到0 mm、25.83 mm提高到3.05 mm、36.6 mm提高到6 mm （χ 2 P < 0.05）。所有严重程度的旋转和侧屈缺陷也得到改善，但没有统计学意义（P < 0.911和P < 0.04）。24例患儿的GA和TD均得到了良好的矫正。4名II级CMT患儿和7名III级CMT患儿的残余平移量为5mm或以上，GA小于中性水平，结果良好。在平均28个月（24-32个月）的随访中，没有儿童出现疤痕美容或突出侧束的问题，也没有畸形复发。GA和TD可用于评估斜颈管理中的FA，即使在严重的情况下也可以预期显着改善。
Assessment of facial asymmetry is challenging in torticollis deformity. Neck tilt in toroticollis is associated with deviation of horizontal ocular gaze and translation of neck from the midline. These deviations can be assessed clinically and can be used as surrogate marker for facial asymmetry. Thirty five children with congenital muscular torticollis (CMT) were classified into three grades of severity based on the new clinical score. The parameters included in the scoring system included rotational deficit, side flexion deficit, gaze angle (GA), and translational deformity (TD). Seven children had Grade I (mild), 18 had Grade II (moderate), and 10 had Grade III (severe) CMT. There were 21 girls and 14 boys with a mean age of 8.46 years (range 3–16 years). Twenty two children underwent a bipolar release, and 13 had unipolar surgery. Facial asymmetry (FA) signs were noted and based on GA and TD; all children had a deviation from the neutral angles (GA of 90° and 0 mm translation from the midsterna plumb line were considered neutral angle). The final outcome was based on the modified Cheng and Tang Score. The mean GA in Grade I, II, and III improved from 81.71 to 90, 72.77 to 89.16, and 66.60 to 88, respectively (Chi-square P < 0.0001). The TD improved from 15 mm to 0 mm, 25.83 mm to 3.05 mm, and 36.6 mm to 6 mm in Grade I, II, and III, respectively (Chi-square P < 0.05). The rotational and side flexion deficits also improved across all grades of severity but were not statistically significant (P < 0.911 and P < 0.04). Twenty four children had an excellent outcome with complete correction of their GA and TD. Four children with Grade II CMT and seven children with Grade III who had a residual translation of 5 mm or more and GA less than neutral horizontal had a good outcome. No child had problems with scar cosmesis or prominent lateral bands, and there was no recurrence of deformity at a mean followup of 28 months (range 24–32 months). The GA and TD can be used to assess FA in torticollis management and significant improvement can be expected even in severe cases.